Provider Demographics
NPI:1497272421
Name:MASON, JAYME LEIGH (APRN)
Entity Type:Individual
Prefix:MS
First Name:JAYME
Middle Name:LEIGH
Last Name:MASON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIGMA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7722
Mailing Address - Country:US
Mailing Address - Phone:843-553-4383
Mailing Address - Fax:843-553-4384
Practice Address - Street 1:7 S ALLIANCE DR STE 211B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7269
Practice Address - Country:US
Practice Address - Phone:843-553-4383
Practice Address - Fax:843-553-4384
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21246363LF0000X
NC5010061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5260Medicaid
SC21246OtherSC APRN LICENSE