Provider Demographics
NPI:1043003841
Name:CRISWELL, JASON D (RN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:CRISWELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 CAROLAND DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7884
Mailing Address - Country:US
Mailing Address - Phone:803-203-3299
Mailing Address - Fax:
Practice Address - Street 1:1000 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7315
Practice Address - Country:US
Practice Address - Phone:803-802-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC252695163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice