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General NPI Number Information
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NPI Number | 1962848697
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Entity Type | Individual
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Provider Name | KIM BLACKWELL RN
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Gender | Female
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 350 NEW HOPE CHURCH RD
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City | JONESVILLE
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State | SC
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Zip | 29353-2325
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Country | US
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Telephone | 864-674-5518
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Fax | 864-674-1890
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Provider Business Mailing Address
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Address Line | 350 NEW HOPE CHURCH RD
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City | JONESVILLE
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State | SC
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Zip | 29353-2325
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Country | US
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Telephone | 864-674-5518
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Fax | 864-674-1890
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 55504
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License Number State | SC
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