Provider Demographics
NPI:1407261845
Name:LE, JESSICA ALICE (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALICE
Last Name:LE
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:SC HOUSE CALLS INC
Mailing Address - Street 2:111 DOCTORS CIRCLE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:912-450-6303
Practice Address - Street 1:SC HOUSE CALLS INC
Practice Address - Street 2:111 DOCTORS CIRCLE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:912-450-6303
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2023-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC24072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6959Medicaid