Provider Demographics
NPI:1396408811
Name:JENNINGS, JOCYLENE ADAMA (LPN)
Entity type:Individual
Prefix:
First Name:JOCYLENE
Middle Name:ADAMA
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JOCYLENE
Other - Middle Name:ADAMA
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1035 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2714
Mailing Address - Country:US
Mailing Address - Phone:864-602-1188
Mailing Address - Fax:
Practice Address - Street 1:1035 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2714
Practice Address - Country:US
Practice Address - Phone:864-602-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51144164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse