Healthcare Provider Details

I. General information

NPI: 1033969373
Provider Name (Legal Business Name): KOURTNIE S VEREEN-JULES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 TWO NOTCH RD
LEXINGTON SC
29072-7963
US

IV. Provider business mailing address

116 GOLDENROD CT
LEXINGTON SC
29073-7099
US

V. Phone/Fax

Practice location:
  • Phone: 803-951-5871
  • Fax:
Mailing address:
  • Phone: 803-269-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number239758
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: