Provider Demographics
NPI:1275117921
Name:TIMMONS, KRISTEN SUBLETTE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUBLETTE
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 HOWLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2449
Mailing Address - Country:US
Mailing Address - Phone:803-236-7070
Mailing Address - Fax:
Practice Address - Street 1:218 HOWLE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2449
Practice Address - Country:US
Practice Address - Phone:803-236-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner