Individual
KIMBERLY MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNPC-AG
Contact information
Practice address
2376 CYPRESS CIR STE 300, CONWAY, SC 29526-8995
(843) 353-3460
Mailing address
210 VILLAGE CENTER BLVD STE 140, MYRTLE BEACH, SC 29579-6706
(843) 353-3460
(843) 353-3461
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
20986
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20986
SC NURSING BOARD
SC
Enumeration date
12/02/2016
Last updated
07/20/2022
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