Healthcare Provider Details

I. General information

NPI: 1306804893
Provider Name (Legal Business Name): PROFESSIONAL NURSING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W FAIRLEE ST
MARION SC
29571-2907
US

IV. Provider business mailing address

115 W FAIRLEE ST
MARION SC
29571-2907
US

V. Phone/Fax

Practice location:
  • Phone: 843-275-0110
  • Fax: 843-275-0228
Mailing address:
  • Phone: 843-275-0110
  • Fax: 843-275-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number71658
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY D. HUNSUCKER
Title or Position: PRESIDENT/CEO
Credential: RN
Phone: 843-275-0110