Provider Demographics
NPI:1821649344
Name:STEPHENS, JACQUELINE G (PHD, APRN, AGNP-C)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:G
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PHD, APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069
Mailing Address - Country:US
Mailing Address - Phone:843-260-8687
Mailing Address - Fax:
Practice Address - Street 1:406 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:SC
Practice Address - Zip Code:29069-2906
Practice Address - Country:US
Practice Address - Phone:843-260-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23281363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care