Individual
MR. JAMIE PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4210
(864) 455-4411
(864) 455-4480
Mailing address
300 E MCBEE AVE STE 300, GREENVILLE, SC 29601-2899
(864) 522-8611
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
22946
SC
363LG0600X
Gerontology Nurse Practitioner
2019027359
MD
363LG0600X
Gerontology Nurse Practitioner
Primary
22946
SC
Other
Enumeration date
08/02/2019
Last updated
12/06/2024
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