Upstate Carolina Medical LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

UPSTATE CAROLINA MEDICAL LLC

Practice address

144 Thomas Green Blvd Ste 232
Clemson, SC 29631-2291

Phone

(864) 722-5203

Fax

(864) 722-5203

NPI assigned

Jan 14, 2022

Last updated

Jun 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jessica Vassallo

Title

Owner/ Nurse Practitioner

Phone

(864) 903-9604

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1642118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1457002123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 THOMAS GREEN BLVD STE 232",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296312291",
            "telephone_number": "864-722-5203",
            "fax_number": "864-722-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 THOMAS GREEN BLVD STE 232",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296312291",
            "telephone_number": "864-722-5203",
            "fax_number": "864-722-5203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Central Park Ln Ste A",
            "address_purpose": "LOCATION",
            "city": "Seneca",
            "state": "SC",
            "postal_code": "296781156",
            "country_code": "US",
            "telephone_number": "864-903-9604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UPSTATE CAROLINA MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-14",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "VASSALLO",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER/ NURSE PRACTITIONER",
        "authorized_official_telephone_number": "864-903-9604"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Clemson, SC
• Providers in Clemson, SC by specialty
• Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.