Provider Demographics
NPI:1639505324
Name:O'BRIANT, JENNIFER LUCAS (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LUCAS
Last Name:O'BRIANT
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 SHUMPERT ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172
Mailing Address - Country:US
Mailing Address - Phone:803-341-5554
Mailing Address - Fax:
Practice Address - Street 1:146 SHUMPERT RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-2458
Practice Address - Country:US
Practice Address - Phone:803-341-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
SCLMW-0074176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula