Active NPI
Christine Stevens Jackson
- Medical Laboratory Technician
- McClellanville, SC
National Provider Identifier
1114286150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Laboratory Technician
- License
- 1600
- Practice address
- 161 Liberty St
MC Clellanville, SC 29458-9721 - Phone
- (843) 230-9297
- NPI assigned
- May 11, 2012
- Last updated
- May 11, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Laboratory Technician | 246RM2200X | 1600 | MT | Primary |
Addresses
Primary practice location
161 Liberty St
MC Clellanville, SC 29458-9721
Mailing address
161 Liberty St
MC Clellanville, SC 29458-9721
Phone (843) 230-9297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1600 | MT | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336694400000",
"number": "1114286150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "161 LIBERTY ST",
"city": "MC CLELLANVILLE",
"state": "SC",
"postal_code": "294589721",
"telephone_number": "843-230-9297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161 LIBERTY ST",
"city": "MC CLELLANVILLE",
"state": "SC",
"postal_code": "294589721",
"telephone_number": "843-230-9297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHRISTINE",
"middle_name": "STEVENS",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-11",
"last_updated": "2012-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "246RM2200X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Medical Laboratory",
"state": "MT",
"license": "1600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McClellanville, SC
- Mary E English, PT
- Debra Elizabeth Erich, FNP-C
- Mark Erich, M.D.
- Deborah Ann Fraser, LPC
- Gail J Guzzo, R.PH., PH.D.
- Windsor Florence Lynch, RDN, LD
- McClellanville Dental LLC
- McClellanville Pharmacy Inc. (McClellanville Drugs)
- McClellanville Physical Therapy, LLC (Mary English PT)
- Isla Ruth Merritt, R.N.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.