Individual
KIMBERLY BENNETT QUALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 GREENE ST, COLUMBIA, SC 29208-4001
(803) 777-7412
Mailing address
1601 GREENE ST, COLUMBIA, SC 29208-4001
(803) 777-7412
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26856
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/02/2021
Last updated
08/24/2023
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