Provider Demographics
NPI:1316293947
Name:KILCOYNE, JAMIE LYNN (NP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:KILCOYNE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 VERDAE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4021
Mailing Address - Country:US
Mailing Address - Phone:864-516-1783
Mailing Address - Fax:
Practice Address - Street 1:525 VERDAE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4021
Practice Address - Country:US
Practice Address - Phone:864-516-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17898363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCE6856084OtherMEDICARE PIN
SCNP2102Medicaid
SCP01110426OtherRAILROAD MEDICARE
SCAA95094722Medicare PIN
SCAA95096067Medicare PIN
SCAA95095214Medicare PIN