Provider Demographics
NPI:1609382597
Name:IRWIN, KIMBERLY D (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:IRWIN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 TRACK RD
Mailing Address - Street 2:
Mailing Address - City:PELION
Mailing Address - State:SC
Mailing Address - Zip Code:29123-9287
Mailing Address - Country:US
Mailing Address - Phone:803-261-7278
Mailing Address - Fax:
Practice Address - Street 1:1847 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7759
Practice Address - Country:US
Practice Address - Phone:803-356-8998
Practice Address - Fax:803-356-8999
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily