Provider Demographics
NPI:1689019465
Name:KIZER, TAMELA S (RN)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:S
Last Name:KIZER
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 1:7184 HIGHWAY 162
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449-5603
Mailing Address - Country:US
Mailing Address - Phone:843-889-3992
Mailing Address - Fax:843-889-6518
Practice Address - Street 1:7184 HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-5603
Practice Address - Country:US
Practice Address - Phone:843-889-3992
Practice Address - Fax:843-889-6518
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39345163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool