Individual
KEENYA KIMBRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
9010 JORDON CRK, FORT MILL, SC 29707-5857
(303) 715-8045
Mailing address
9010 JORDON CRK, FORT MILL, SC 29707-5857
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PR 39938
SC
Other
Enumeration date
05/21/2007
Last updated
07/28/2007
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