Healthcare Provider Details

I. General information

NPI: 1295256337
Provider Name (Legal Business Name): KIM JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 HERITAGE LN UNIT B
FLORENCE SC
29505-3197
US

IV. Provider business mailing address

1523 HERITAGE LN UNIT B
FLORENCE SC
29505-3197
US

V. Phone/Fax

Practice location:
  • Phone: 843-673-0900
  • Fax:
Mailing address:
  • Phone: 843-673-0900
  • Fax: 843-665-5851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number213206
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP39373
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number21086
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: