Healthcare Provider Details

I. General information

NPI: 1053284661
Provider Name (Legal Business Name): KIERSTEN R WILLIMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BROAD ST
SUMTER SC
29150-4152
US

IV. Provider business mailing address

130 HIDDEN BAY DR
SUMTER SC
29154-4706
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-5227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: