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General NPI Number Information
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NPI Number | 1144118084
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Entity Type | Individual
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Provider Name | JOHN KIBET KIRUI
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Gender | Male
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 201 CENTRAL PARK LN STE A
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City | SENECA
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State | SC
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Zip | 29678-1156
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Country | US
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Telephone | 864-844-9432
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Fax | 864-844-9430
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Provider Business Mailing Address
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Address Line | 430 KINGSTON TRACE RD
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City | COLUMBIA
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State | SC
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Zip | 29229-7691
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Country | US
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Telephone | 218-576-9867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12749
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 30234
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License Number State | SC
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