Provider Demographics
NPI:1497451488
Name:BUSBY FELDER, KIZMIT
Entity Type:Individual
Prefix:
First Name:KIZMIT
Middle Name:
Last Name:BUSBY FELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 RHOAD ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2422
Mailing Address - Country:US
Mailing Address - Phone:803-290-8652
Mailing Address - Fax:
Practice Address - Street 1:1547 RHOAD ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2422
Practice Address - Country:US
Practice Address - Phone:803-290-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No376J00000XNursing Service Related ProvidersHomemaker