Provider Demographics
NPI:1548845944
Name:BROWN, JESSICA POWELL (APRN)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:POWELL
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MONTAGUE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-9027
Mailing Address - Country:US
Mailing Address - Phone:864-519-0054
Mailing Address - Fax:864-447-5707
Practice Address - Street 1:1225 MONTAGUE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-9027
Practice Address - Country:US
Practice Address - Phone:864-519-0054
Practice Address - Fax:864-447-5707
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24785363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
104072102OtherNATIONAL CERTIFICATION CORPORATION ID
SC24785OtherSC LLR BOARD OF NURSING
1548845944OtherNPI