Provider Demographics
NPI:1467472407
Name:FREEMAN, JACQUELYN B (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:B
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-2408
Mailing Address - Country:US
Mailing Address - Phone:864-855-5006
Mailing Address - Fax:864-850-1992
Practice Address - Street 1:1351 CRESTVIEW RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-2408
Practice Address - Country:US
Practice Address - Phone:864-855-5006
Practice Address - Fax:864-850-1992
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2404363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0194Medicaid
SC7112Medicare PIN
SCP26259Medicare UPIN