Provider Demographics
NPI:1891313730
Name:JENNINGS, CRYSTAL ANN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5384
Mailing Address - Country:US
Mailing Address - Phone:803-909-9598
Mailing Address - Fax:803-909-9301
Practice Address - Street 1:331 E. MAIN ST., SUITE 200
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730
Practice Address - Country:US
Practice Address - Phone:803-909-9598
Practice Address - Fax:803-909-9301
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1594171W00000X
172V00000X, 174H00000X, 246RP1900X, 251E00000X, 251G00000X, 310400000X, 343900000X, 372600000X, 3747P1801X, 374U00000X, 385H00000X, 385HR2065X, 390200000X
SC166695376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC166696OtherCNA
NC419524OtherCNA