Healthcare Provider Details

I. General information

NPI: 1194472605
Provider Name (Legal Business Name): KIANA CHEVONNE BROWN RN ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W EVANS ST STE D100
FLORENCE SC
29501-3376
US

IV. Provider business mailing address

1801 W EVANS ST STE D100
FLORENCE SC
29501-3376
US

V. Phone/Fax

Practice location:
  • Phone: 843-506-6817
  • Fax: 888-781-9149
Mailing address:
  • Phone: 843-506-6817
  • Fax: 888-781-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number235320
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number235320
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number235320
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number235320
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: