Individual provider Active NPI

Jessica Thompson Spivey, NURSE PRACTITIONER

  • Nurse Practitioner
  • Loris, SC
National Provider Identifier
1164216933
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
30199 Issued in SC
Practice address
3485 Mitchell St
Loris, SC 29569-2823
Phone
(843) 390-0877
NPI assigned
Apr 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 30199 SC Primary

Addresses

Primary practice location

3485 Mitchell St
Loris, SC 29569-2823

Mailing address

3485 Mitchell St
Loris, SC 29569-2823

Other practice location 1

3793 McDowell Ln Ste 220
Little River, SC 29566-7892
Phone (843) 366-3008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250521001783 SC Practitioner - Nurse Practitioner 9638698863 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Carolina School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3793 McDowell LN
Suite 200
Little River, SC 29566-7892
Phone (843) 390-0877

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince May 1, 2025 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince May 1, 2025 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc Past Accepting new patients

Locations

555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233

3793 McDowell Ln
Ste 200
Little River, SC 29566
Phone (843) 390-0877

3485 Mitchell St
Loris, SC 29569
Phone (843) 390-0877

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1164216933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 MITCHELL ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3485 MITCHELL ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692823",
            "telephone_number": "843-390-0877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3793 McDowell Ln Ste 220",
            "address_purpose": "LOCATION",
            "city": "Little River",
            "state": "SC",
            "postal_code": "295667892",
            "country_code": "US",
            "telephone_number": "843-366-3008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPIVEY",
        "first_name": "JESSICA",
        "middle_name": "THOMPSON",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-07",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "30199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loris, SC

Sources for this page

Verify at the official NPI Registry.