Healthcare Provider Details

I. General information

NPI: 1205791902
Provider Name (Legal Business Name): KIRSTON ANSLEY STOKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 N GUIGNARD DR
SUMTER SC
29150-4029
US

IV. Provider business mailing address

462 N GUIGNARD DR
SUMTER SC
29150-4029
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-7783
  • Fax: 803-774-7783
Mailing address:
  • Phone: 803-774-7783
  • Fax: 803-774-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8788
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: