Provider Demographics
NPI:1700523768
Name:LEE, JADE A (MSN)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:A
Other - Last Name:SECKINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2605
Mailing Address - Country:US
Mailing Address - Phone:843-987-7400
Mailing Address - Fax:
Practice Address - Street 1:776 2ND ST E
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-4926
Practice Address - Country:US
Practice Address - Phone:803-625-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily