Healthcare Provider Details

I. General information

NPI: 1053225003
Provider Name (Legal Business Name): KIMBERLEY MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N SHELBY ST STE B
BLACKSBURG SC
29702-1538
US

IV. Provider business mailing address

108 N SHELBY ST STE B
BLACKSBURG SC
29702-1538
US

V. Phone/Fax

Practice location:
  • Phone: 864-216-1519
  • Fax:
Mailing address:
  • Phone: 864-216-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: