Healthcare Provider Details

I. General information

NPI: 1689780553
Provider Name (Legal Business Name): KIMBERLY B SPEER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COMMONWEALTH DR STE 120
GREENVILLE SC
29615-4881
US

IV. Provider business mailing address

507 BOULEVARD
ANDERSON SC
29621-4005
US

V. Phone/Fax

Practice location:
  • Phone: 864-675-4601
  • Fax: 864-675-4604
Mailing address:
  • Phone: 864-964-1642
  • Fax: 864-675-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2948
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: