Healthcare Provider Details

I. General information

NPI: 1710505078
Provider Name (Legal Business Name): KRISTEN GINSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 S LIVE OAK DR UNIT C
MONCKS CORNER SC
29461-8762
US

IV. Provider business mailing address

112 SALUDA RIDGE CT STE 200
WEST COLUMBIA SC
29169-3461
US

V. Phone/Fax

Practice location:
  • Phone: 843-714-2005
  • Fax:
Mailing address:
  • Phone: 803-999-1750
  • Fax: 803-999-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23823
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: