Provider Demographics
NPI:1598209652
Name:COGGINS, JACKIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:
Last Name:COGGINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2614
Mailing Address - Country:US
Mailing Address - Phone:864-984-7777
Mailing Address - Fax:864-984-2926
Practice Address - Street 1:200 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2614
Practice Address - Country:US
Practice Address - Phone:864-984-7777
Practice Address - Fax:864-984-2926
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25500163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool