Provider Demographics
NPI:1255517728
Name:CUNNINGHAM, JAMIE D (ACNP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:D
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:D
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0099
Mailing Address - Country:US
Mailing Address - Phone:803-254-3278
Mailing Address - Fax:803-255-2715
Practice Address - Street 1:2001 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1018
Practice Address - Country:US
Practice Address - Phone:803-254-3278
Practice Address - Fax:803-255-2715
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3442363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1180Medicaid