Healthcare Provider Details

I. General information

NPI: 1730229824
Provider Name (Legal Business Name): KIM BRIGITTE WINSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM THI-THIEN NGUYEN NP

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 BROAD RIVER RD
COLUMBIA SC
29210-4016
US

IV. Provider business mailing address

4650 BROAD RIVER RD
COLUMBIA SC
29210-4016
US

V. Phone/Fax

Practice location:
  • Phone: 803-896-9460
  • Fax:
Mailing address:
  • Phone: 803-896-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number197336
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26187
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number197336
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: