Individual
MRS. ROBERTA JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
853 N CHURCH ST, SUITE 510, SPARTANBURG, SC 29303-3098
(864) 560-6193
(864) 560-1510
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN2321
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196540
MEDCOST
SC
01
—
CN1627
RR MEDICARE
SC
05
—
NP0240
—
SC
Enumeration date
01/30/2006
Last updated
03/14/2013
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