Provider Demographics
NPI:1992281513
Name:STOKES, JENNIFER LEA (NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:STOKES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4162
Mailing Address - Country:US
Mailing Address - Phone:803-432-8622
Mailing Address - Fax:803-432-8624
Practice Address - Street 1:1045 W DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4162
Practice Address - Country:US
Practice Address - Phone:803-432-8622
Practice Address - Fax:803-432-8624
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22055363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology