MEDICARE: KRISTEN SUBLETTE TIMMONS MSN, APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	24908	SC

General Provider Information

NPI Number	:	1275117921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN SUBLETTE TIMMONS MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	218 HOWLE AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2449
Country	:	US
Telephone Number	:	803-236-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 HOWLE AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2449
Country	:	US
Telephone Number	:	803-236-7070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	01/23/2024

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