Healthcare Provider Details

I. General information

NPI: 1760617005
Provider Name (Legal Business Name): KIMBERLY MARIE KINKADE APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 CHARLIE HALL BLVD
CHARLESTON SC
29414-5834
US

IV. Provider business mailing address

PO BOX 602108
CHARLOTTE NC
28260-2108
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-2535
  • Fax: 843-573-2534
Mailing address:
  • Phone: 843-573-2535
  • Fax: 843-573-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number25520
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: