Healthcare Provider Details

I. General information

NPI: 1477489821
Provider Name (Legal Business Name): MONIQUE KINSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 SAXON SHORE RD
COLUMBIA SC
29209-4139
US

IV. Provider business mailing address

2416 SAXON SHORE RD
COLUMBIA SC
29209-4139
US

V. Phone/Fax

Practice location:
  • Phone: 804-873-3697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number287097
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: