Provider Demographics
NPI:1144118084
Name:KIRUI, JOHN KIBET
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KIBET
Last Name:KIRUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 KINGSTON TRACE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7691
Mailing Address - Country:US
Mailing Address - Phone:218-576-9867
Mailing Address - Fax:
Practice Address - Street 1:201 CENTRAL PARK LN STE A
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1156
Practice Address - Country:US
Practice Address - Phone:864-844-9432
Practice Address - Fax:864-844-9430
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12749363LP0808X
SC30234363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health