Provider Demographics
NPI:1720493711
Name:CARN, JESSICA CANTLEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CANTLEY
Last Name:CARN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4944
Mailing Address - Country:US
Mailing Address - Phone:803-268-5760
Mailing Address - Fax:
Practice Address - Street 1:1550 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4944
Practice Address - Country:US
Practice Address - Phone:803-268-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95794163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse