Provider Demographics
NPI:1750482824
Name:LEWIS, JILL CARTER (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CARTER
Last Name:LEWIS
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 1:325 BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4167
Mailing Address - Country:US
Mailing Address - Phone:803-773-5227
Mailing Address - Fax:803-418-0202
Practice Address - Street 1:4700 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3119
Practice Address - Country:US
Practice Address - Phone:803-256-1511
Practice Address - Fax:803-256-7333
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1811Medicaid
SCAA6131F935Medicare PIN
SCNP1811Medicaid