Individual provider Active NPI

Jeana Nicole Richardson

  • Maternal Newborn Registered Nurse
  • Conway, SC
National Provider Identifier
1376103564
Registry record updated Jun 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal Newborn Registered NurseTaxonomy code 163WM0102X
License
211857 Issued in SC
Practice address
1931 Industrial Park Rd
Conway, SC 29526-5482
Phone
(834) 915-8800
NPI assigned
Jun 19, 2019
Last updated
Jun 19, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Maternal Newborn Registered Nurse 163WM0102X 211857 SC Primary

Addresses

Primary practice location

1931 Industrial Park Rd
Conway, SC 29526-5482

Mailing address

262 Oak Landing Dr
Conway, SC 29527-7787
Phone (843) 283-9807

Other practice location 1

262 Oak Landing Dr
Conway, SC 29527-7787
Phone (843) 283-9807

Other practice location 2

300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone (843) 347-7111

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

LicenseStateTypeSpecialty
211857SCMDMaternal Newborn Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1376103564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 OAK LANDING DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295277787",
            "telephone_number": "843-283-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1931 INDUSTRIAL PARK RD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295265482",
            "telephone_number": "834-915-8800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "262 Oak Landing Dr",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "SC",
            "postal_code": "295277787",
            "country_code": "US",
            "telephone_number": "843-283-9807",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Singleton Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "SC",
            "postal_code": "295269142",
            "country_code": "US",
            "telephone_number": "843-347-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "JEANA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-19",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "SC",
            "license": "211857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; 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.