Provider Demographics
NPI:1639156540
Name:FRENCH, JACQUELYN PAIGE (APRN, BC,RN,CS,NP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:PAIGE
Last Name:FRENCH
Suffix:
Gender:F
Credentials:APRN, BC,RN,CS,NP
Other - Prefix:MS
Other - First Name:JACQUELYN PAIGE
Other - Middle Name:WESTMORELAND
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 602108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2108
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:1003 LANDFALL WAY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-6323
Practice Address - Country:US
Practice Address - Phone:843-768-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024-165409363L00000X
SC22883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7793219Medicaid
VA018155C18Medicare PIN
P05684Medicare UPIN
VA7793219Medicaid