Provider Demographics
NPI:1255656070
Name:BEAN, KIMBERLY A (NP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:BEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:PLOUSSAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5454
Mailing Address - Country:US
Mailing Address - Phone:843-522-7843
Mailing Address - Fax:843-522-5945
Practice Address - Street 1:122 OKATIE CENTER BLVD N STE 310
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-3782
Practice Address - Country:US
Practice Address - Phone:843-706-8690
Practice Address - Fax:844-295-9802
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4230363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB8689125OtherMEDICARE PTAN
SCP01510934OtherRAILROAD MEDICARE
SCNP1618Medicaid
SCNP1618Medicaid
SCAA51106084Medicare PIN