Provider Demographics
NPI:1841605078
Name:BOVA, KIMBERLY A (DNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BOVA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:213 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6541
Practice Address - Country:US
Practice Address - Phone:843-873-0681
Practice Address - Fax:843-873-2749
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2836Medicaid
SCP01396733OtherRR MEDICARE
SCSC42685282Medicare PIN
SCSC42686882Medicare PIN
SCSC42686834Medicare PIN
SCSC42688798Medicare PIN
SCSC42687006Medicare PIN
SCSC42687819Medicare PIN
SCSC42685281Medicare PIN
SCSC42687126Medicare PIN
SCSC42687498Medicare PIN
SCSC42687499Medicare PIN
SCSC42687522Medicare PIN
SCP01396733OtherRR MEDICARE
SCSC42687555Medicare PIN
SCSC42685277Medicare PIN