Healthcare Provider Details

I. General information

NPI: 1528307618
Provider Name (Legal Business Name): KIMBERLY R MCCLAIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 S GREENWOOD AVE
WARE SHOALS SC
29692-1541
US

IV. Provider business mailing address

56 S GREENWOOD AVE
WARE SHOALS SC
29692-1541
US

V. Phone/Fax

Practice location:
  • Phone: 864-456-7496
  • Fax: 864-456-2959
Mailing address:
  • Phone: 864-456-7496
  • Fax: 864-456-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number87755
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: