Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Larry Randolph Jackson, REGISTEREDNURSE

Individual provider Psychiatric/Mental Health Registered Nurse · NPI 1093878191

Mr. Larry Randolph Jackson, REGISTEREDNURSE is a Psychiatric/Mental Health Registered Nurse in Columbia, South Carolina. Practices as a sole proprietor. Licensed in South Carolina.

Licensed in
SC
In the registry since
2006

Practice location Address checks out

615 Rapids Rd
Columbia, SC 29212-3024
Phone: (803) 798-2211
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Registered Nurse (primary) Taxonomy 163WP0808X · Licence 56879 (SC)

Record details

NPI number1093878191
Entity typeIndividual (Type 1)
GenderMale
Credentials REGISTEREDNURSE
Sole proprietorYes
NPI enumeratedDecember 19, 2006
Last updated in NPPESJuly 8, 2007

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