Provider Demographics
NPI:1134829849
Name:POLEY, JESSICA M (APRN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:POLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 WILLIAM H JOHNSON ST STE 600
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2773
Mailing Address - Country:US
Mailing Address - Phone:843-667-1891
Mailing Address - Fax:
Practice Address - Street 1:101 WILLIAM H JOHNSON ST STE 600
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2773
Practice Address - Country:US
Practice Address - Phone:843-667-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26932363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner