Provider Demographics
NPI:1316626005
Name:BRISTER, JESSICA ROSE (NP, RN, APN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:BRISTER
Suffix:
Gender:F
Credentials:NP, RN, APN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ROSE
Other - Last Name:STAMBELU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3459 CLAREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9341
Mailing Address - Country:US
Mailing Address - Phone:845-238-4747
Mailing Address - Fax:
Practice Address - Street 1:86 JONATHAN LUCAS ST HOLLINGS CANCER CENTER
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350634363LF0000X
SC27913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily