Provider Demographics
NPI:1841913845
Name:STAYTON, JENNIFER LEAH (APRN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEAH
Last Name:STAYTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4969 CENTRE POINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6975
Mailing Address - Country:US
Mailing Address - Phone:843-725-5444
Mailing Address - Fax:843-266-9124
Practice Address - Street 1:4969 CENTRE POINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6975
Practice Address - Country:US
Practice Address - Phone:843-725-5444
Practice Address - Fax:843-266-9124
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26757363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily