Provider Demographics
NPI:1861039687
Name:GRANT, JAIMIE ELIZABETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5368
Mailing Address - Country:US
Mailing Address - Phone:864-612-8701
Mailing Address - Fax:
Practice Address - Street 1:8020 WHITE AVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2043
Practice Address - Country:US
Practice Address - Phone:864-612-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-01
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily