Provider Demographics
NPI:1063989317
Name:JENKINS, CASSIE CALLAHAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:CALLAHAN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:1580 LEE ORMAND RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-6113
Mailing Address - Country:US
Mailing Address - Phone:803-577-1560
Mailing Address - Fax:
Practice Address - Street 1:1025 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2204
Practice Address - Country:US
Practice Address - Phone:803-285-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine