IndividualActive
Larry Jackson, REGISTERED NURSE
NPI 1093878191 · Psychiatric/Mental Health Registered Nurse · Columbia, SC
Provider details
- NPI number
- 1093878191
- Entity type
- Individual
- Primary specialty
- Psychiatric/Mental Health Registered NurseNursing Service Providers
- Credential
- REGISTERED NURSE
- Sex
- Male
- Sole proprietor
- Yes
- License
- 56879 (SC)
Specialties & taxonomies
Nursing Service Providers
Practice location
615 Rapids Rd
Columbia, SC 29212-3024
Phone: (803) 798-2211
Approximate (ZIP-level) locationGet directions
Mailing address
615 Rapids Rd
Columbia, SC 29212-3024
Registry dates
- Enumerated
- 2006-12-19
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.