Healthcare Provider Details

I. General information

NPI: 1285550426
Provider Name (Legal Business Name): KIMBERLY MONIQUE CAMPBELL LICENSED BRAIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7013 DORCHESTER RD STE B
NORTH CHARLESTON SC
29418-4200
US

IV. Provider business mailing address

7013 DORCHESTER RD STE B
NORTH CHARLESTON SC
29418-4200
US

V. Phone/Fax

Practice location:
  • Phone: 843-847-0761
  • Fax:
Mailing address:
  • Phone: 843-847-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: