Individual
NINA KATHERINE TRENT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
209 PATEWOOD DR STE 200, GREENVILLE, SC 29615-3589
(864) 522-6630
(864) 522-6635
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 695-6697
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1563
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1081PA
—
SC
Enumeration date
09/27/2010
Last updated
01/15/2025
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