Provider Demographics
NPI:1710519475
Name:FEAGIN, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FEAGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N. JONES ROAD
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:SC
Mailing Address - Zip Code:29162
Mailing Address - Country:US
Mailing Address - Phone:843-396-4457
Mailing Address - Fax:843-396-9512
Practice Address - Street 1:312 N. JONES ROAD
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29162
Practice Address - Country:US
Practice Address - Phone:843-396-4457
Practice Address - Fax:843-396-9512
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC71429163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNAMedicaid