Healthcare Provider Details

I. General information

NPI: 1972964302
Provider Name (Legal Business Name): KIRSTEN APRIL BECKSVOORT D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2016
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W WESMARK BLVD
SUMTER SC
29150
US

IV. Provider business mailing address

325 BROAD ST STE 100
SUMTER SC
29150-4167
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-5227
  • Fax: 803-905-1322
Mailing address:
  • Phone: 803-773-5227
  • Fax: 803-418-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82961
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: