Individual provider · Type 1 NPI

Jena W. Nickles, PA

Surgical Physician Assistant · Mount Pleasant, SC

NPI number 1821399106 Active

Practice location

180 Wingo Way, Suite 301
Mount Pleasant, SC 29464-1810

Call (843) 884-0302 Map

Fax (843) 849-9308

Mailing address

PO Box 751649
Charlotte, NC 28275-1649

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X1585 (SC)

Surgical Physician Assistant: Definition to come...

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About NPI 1821399106

Jena W. Nickles, PA's National Provider Identifier is 1821399106, issued on Nov 3, 2010. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Mount Pleasant, SC. The record was last updated on Jan 24, 2017.