Individual
KELLEY WALLACE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP/FNP
Contact information
Practice address
705 N 8TH AVE STE 1A, DILLON, SC 29536-2549
(843) 774-2478
(843) 774-1826
Mailing address
705 N 8TH AVE STE 1A, DILLON, SC 29536-2549
(843) 774-2478
(843) 774-1826
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
18972
SC
Other
Enumeration date
04/21/2014
Last updated
07/28/2014
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