Healthcare Provider Details

I. General information

NPI: 1609265255
Provider Name (Legal Business Name): KIMBERLY CHIPMAN RN, BSN, J.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST SUITE 9
SUMMERVILLE SC
29483-6439
US

IV. Provider business mailing address

500 N MAIN ST SUITE 9
SUMMERVILLE SC
29483-6439
US

V. Phone/Fax

Practice location:
  • Phone: 843-832-0041
  • Fax:
Mailing address:
  • Phone: 843-832-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0000143122
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: