Jennifer N Davis, IN HOME CARE PROVIDE

Primary specialty

Attendant Care ProviderTaxonomy code 3747A0650X

License

IHCP-2122 Issued in SC

Practice address

178 Beretta Dr
Eutawville, SC 29048-8600

Phone

(843) 367-3431

NPI assigned

Apr 11, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Care 1 Seniors Center

  • Home Health Aide
  • Eutawville, SC
  • NPI 1750183588
  NPD Authorized official

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

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1205689809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 BERETTA DR",
            "city": "EUTAWVILLE",
            "state": "SC",
            "postal_code": "290488600",
            "telephone_number": "843-367-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 BERETTA DR",
            "city": "EUTAWVILLE",
            "state": "SC",
            "postal_code": "290488600",
            "telephone_number": "843-367-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JENNIFER",
        "middle_name": "N",
        "credential": "IN HOME CARE PROVIDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "SC",
            "license": "IHCP-2122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristianna L Bordelon, IBCLC
• Kelsey Gainey Campbell, LPN
• Care 1 Seniors Center
• Delta Palms Assisted Living LLC
• Vernell Dottery
• Eutawville Pharmacy
• Shakelia Fogle
• Harry Green Jr., MPT

• Attendant Care Provider in Eutawville, SC
• Providers in Eutawville, SC by specialty
• Attendant Care Provider in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.