Healthcare Provider Details

I. General information

NPI: 1235111543
Provider Name (Legal Business Name): BEVERLY H TIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E MARION ST
KERSHAW SC
29067-1442
US

IV. Provider business mailing address

PO BOX 1259
CAMDEN SC
29021-1259
US

V. Phone/Fax

Practice location:
  • Phone: 803-475-3475
  • Fax: 803-475-5360
Mailing address:
  • Phone: 803-713-8350
  • Fax: 803-713-8433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN587
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: