Healthcare Provider Details

I. General information

NPI: 1386609931
Provider Name (Legal Business Name): LAURA LEE KINNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 ASHLEY CROSSING DR STE 165
CHARLESTON SC
29414-5865
US

IV. Provider business mailing address

PO BOX 13955
CHARLESTON SC
29422-3955
US

V. Phone/Fax

Practice location:
  • Phone: 843-936-4455
  • Fax: 843-268-2670
Mailing address:
  • Phone: 843-225-8320
  • Fax: 843-225-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberSCLN19466
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: