Individual
NICOLE KONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4210
(864) 455-4411
(864) 455-4480
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
CP001709
SD
363LF0000X
Family Nurse Practitioner
2013000129
MO
363LF0000X
Family Nurse Practitioner
Primary
26862
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558608067
—
MO
05
—
196346758
—
AR
01
—
431560263
TRICARE
MO
05
—
NP9596
—
SC
01
—
P01160135
RR MCR
MO
Enumeration date
01/04/2013
Last updated
03/27/2023
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