Provider Demographics
NPI:1679918478
Name:BEARDEN, KIMBERLY (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S BOUNDARY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ELLENTON
Mailing Address - State:SC
Mailing Address - Zip Code:29809-3206
Mailing Address - Country:US
Mailing Address - Phone:803-652-8170
Mailing Address - Fax:803-652-8173
Practice Address - Street 1:505 S BOUNDARY AVE
Practice Address - Street 2:
Practice Address - City:NEW ELLENTON
Practice Address - State:SC
Practice Address - Zip Code:29809-3206
Practice Address - Country:US
Practice Address - Phone:803-652-8170
Practice Address - Fax:803-652-8173
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99782163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool