Active NPI
Jacob Coward
- Pediatric Nurse Practitioner
- Hartsville, SC
National Provider Identifier
1396939971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 3317
- Practice address
- 518 E Carolina Ave Ste B
Hartsville, SC 29550-4312 - Phone
- (843) 383-4426
- Fax
- (843) 383-8509
- NPI assigned
- Aug 28, 2007
- Last updated
- Jul 15, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 3317 | SC | Primary |
Addresses
Primary practice location
518 E Carolina Ave Ste B
Hartsville, SC 29550-4312
Mailing address
518 E Carolina Ave Ste B
Hartsville, SC 29550-4312
Phone (843) 383-4426
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20066947 | Other | SC | SELECT HEALTH |
| 3317 | Other | SC | SC LICENSE # |
| NP1148 | Medicaid | SC |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3317 | SC | MD | Veterinarian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caring Hearts Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Hartsville, SC
- NPI 1982961793
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436918400000",
"number": "1396939971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "518 E CAROLINA AVE STE B",
"city": "HARTSVILLE",
"state": "SC",
"postal_code": "295504312",
"telephone_number": "843-383-4426",
"fax_number": "843-383-8509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "518 E CAROLINA AVE STE B",
"city": "HARTSVILLE",
"state": "SC",
"postal_code": "295504312",
"telephone_number": "843-383-4426",
"fax_number": "843-383-8509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COWARD",
"first_name": "JACOB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-28",
"last_updated": "2015-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "SC",
"license": "3317",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SELECT HEALTH",
"identifier": "20066947",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC LICENSE #",
"identifier": "3317",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NP1148",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hartsville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.