Provider Demographics
NPI:1962545574
Name:TURNER, JENNIFER R (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:TURNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 GREGG ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2618
Mailing Address - Country:US
Mailing Address - Phone:803-779-1420
Mailing Address - Fax:803-931-0676
Practice Address - Street 1:1910 GREGG ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2618
Practice Address - Country:US
Practice Address - Phone:803-779-1420
Practice Address - Fax:803-931-0676
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1175363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1175OtherSTATE LICENSE