Healthcare Provider Details

I. General information

NPI: 1780628818
Provider Name (Legal Business Name): KIMBERLY W TOLSON APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COMMONWEALTH DR SUITE 120
GREENVILLE SC
29615-4831
US

IV. Provider business mailing address

100 EAGLESTON LN
SIMPSONVILLE SC
29680-6278
US

V. Phone/Fax

Practice location:
  • Phone: 864-675-4603
  • Fax: 864-675-4604
Mailing address:
  • Phone: 864-399-9393
  • Fax: 864-399-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF54361
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: