Healthcare Provider Details

I. General information

NPI: 1144083494
Provider Name (Legal Business Name): KIMBERLY MCCLURE CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ELIZABETH MCCLURE PA

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-3616
US

IV. Provider business mailing address

135 RUTLEDGE AVE
CHARLESTON SC
29425-8903
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: