Jerelyn S Russell

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

172V00000X Issued in SC

Practice address

1077 Kincaid Bridge Rd.
Winnsboro, SC 29180

Phone

(803) 635-9416

Fax

(803) 815-0403

NPI assigned

Dec 1, 2008

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1228089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228089600000",
    "number": "1801041124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 N VANDERHORST ST",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291801324",
            "telephone_number": "803-718-3121",
            "fax_number": "803-815-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1077 KINCAID BRIDGE RD.",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "29180",
            "telephone_number": "803-635-9416",
            "fax_number": "803-815-0403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JERELYN",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-01",
        "last_updated": "2008-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "SC",
            "license": "101Y00000X",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "SC",
            "license": "172V00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Reynolds
• Renada Richardson, M.A., CACP-I
• Kannetria Halona Robinson-Davis, FNP
• Kayleigh M Rushford, FNP
• Agnes Macfie Russell
• Melisa Russell
• SC Department of Juvenile Justice
• Mary Ann Seegars, PTA
• Mark Edward Shaffer, MD
• Jacob Winton Shaw, NP

• Community Health Worker in Winnsboro, SC
• Providers in Winnsboro, SC by specialty
• Community Health Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; 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.