Provider Demographics
NPI:1558707638
Name:WEBB, JAMIE ROBERTS (LPN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROBERTS
Last Name:WEBB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 MARTIN LUTHER KING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4104
Mailing Address - Country:US
Mailing Address - Phone:843-355-6823
Mailing Address - Fax:843-355-1523
Practice Address - Street 1:616 MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4104
Practice Address - Country:US
Practice Address - Phone:843-355-6823
Practice Address - Fax:843-355-1523
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP40392164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse