Individual
KIMBERLY OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1594 FREEDOM BLVD, FLORENCE, SC 29505-6046
(843) 664-9696
Mailing address
1594 FREEDOM BLVD, FLORENCE, SC 29505-6046
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
19975
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19975
SC MEDICAL LICENSE
SC
Enumeration date
07/21/2016
Last updated
10/22/2020
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