Healthcare Provider Details

I. General information

NPI: 1750120937
Provider Name (Legal Business Name): KIMBERLY DENISE CORN MSN, RN, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W MAIN ST STE A
LEXINGTON SC
29072-2515
US

IV. Provider business mailing address

1130 FRICK RD
BLYTHEWOOD SC
29016-8439
US

V. Phone/Fax

Practice location:
  • Phone: 803-785-8485
  • Fax: 803-785-8486
Mailing address:
  • Phone: 803-518-9479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number204457
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number204457
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: