Individual
JENNIFER DAWN PSALTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
151 PEACHWOOD CENTRE DR, SPARTANBURG, SC 29301-2575
(864) 560-9627
(864) 562-5470
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19465
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3262
—
SC
01
—
SC61005019
MEDICARE PIN
SC
01
—
SC61006067
MEDICARE PIN
SC
01
—
SC61006121
MEDICARE PIN
SC
01
—
SC6100J577
MEDICARE PIN
SC
Enumeration date
06/10/2015
Last updated
12/07/2020
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