Provider Demographics
NPI:1245919224
Name:PARDUE, JENNIFER LYNN (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:PARDUE
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 1:109 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9348
Mailing Address - Country:US
Mailing Address - Phone:843-834-5483
Mailing Address - Fax:
Practice Address - Street 1:200 PRISON RD
Practice Address - Street 2:
Practice Address - City:ENOREE
Practice Address - State:SC
Practice Address - Zip Code:29335-2719
Practice Address - Country:US
Practice Address - Phone:803-729-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27559207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine