Provider Demographics
NPI:1659877868
Name:DRAISEN, JESSICA W (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:W
Last Name:DRAISEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-5880
Mailing Address - Fax:864-375-1347
Practice Address - Street 1:160 PERPETUAL SQ
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1713
Practice Address - Country:US
Practice Address - Phone:864-512-5880
Practice Address - Fax:864-375-1347
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21823363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner