Provider Demographics
NPI:1689024473
Name:MOUZON, KIMBERLY CELESTE (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CELESTE
Last Name:MOUZON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:CELESTE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-791-2000
Mailing Address - Fax:
Practice Address - Street 1:3016 LONGTOWN COMMONS DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7862
Practice Address - Country:US
Practice Address - Phone:803-314-0500
Practice Address - Fax:803-314-0501
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20236363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily