Jennifer Lynn Anderson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA4330 Issued in SC

Practice address

459 N Highway 52
Moncks Corner, SC 29461-3924

Phone

(843) 899-3870

NPI assigned

Nov 30, 2007

Last updated

Sep 29, 2022By the provider in NPPES

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

Other names 1

• Jennifer Riley Anderson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  • NPI 1194902916
  NPD (past)

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1306028436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2243 SANDY POINT LN",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294669203",
            "telephone_number": "775-544-1869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "459 N HIGHWAY 52",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613924",
            "telephone_number": "843-899-3870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "975 Ryland St",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895021667",
            "country_code": "US",
            "telephone_number": "775-982-5000",
            "fax_number": "775-982-3900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "631 Johnnie Dodds Blvd",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "SC",
            "postal_code": "294643030",
            "country_code": "US",
            "telephone_number": "843-881-0815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-30",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1077",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "PA4330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "ANDERSON",
            "middle_name": "RILEY",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jenna Riad Amro
• An Angels Touch
• Robert M Anders, MD
• Amelia H Anderson
• James Anderson II
• Stefanie Anderson, PT, DPT
• Appel & Appel Vision L L C
• Martin S Appel, O.D.
• Dominic J Aquino, LPCA
• Arcis Healthcare (Lowcountry Orthopaedics & Sports Medicine)

• Physician Assistant in Moncks Corner, SC
• Providers in Moncks Corner, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.