Individual
KIMBERLY DUNBAR COONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7182 WOODROW ST STE 200, IRMO, SC 29063-2958
(803) 749-1111
(803) 749-0050
Mailing address
7182 WOODROW ST STE 200, IRMO, SC 29063-2958
(803) 749-1111
(803) 749-0050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
TL1794
SC
363AM0700X
Medical Physician Assistant
Primary
0010-08372
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1794
PA-C MEDICAL LICENSE
SC
Enumeration date
07/16/2012
Last updated
06/11/2022
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