Healthcare Provider Details

I. General information

NPI: 1205717808
Provider Name (Legal Business Name): KIMBERLY STEPHANIA ESCOBAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAROLINA PL STE 101
FORT MILL SC
29708-0015
US

IV. Provider business mailing address

5708 PYRITE CIR
FORT MILL SC
29708-8455
US

V. Phone/Fax

Practice location:
  • Phone: 803-547-4922
  • Fax:
Mailing address:
  • Phone: 631-449-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30939
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: