Individual
MRS. JACQUELINE MICHELE HEADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN RN
Contact information
Practice address
700 21ST AVE N, MYRTLE BEACH, SC 29577-7400
(843) 448-8407
Mailing address
2887 OPHELIA WAY, MYRTLE BEACH, SC 29577-6784
(734) 621-3158
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
244146
SC
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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