Provider Demographics
NPI:1962848697
Name:BLACKWELL, KIM (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:BLACKWELL
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 1:350 NEW HOPE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29353-2325
Mailing Address - Country:US
Mailing Address - Phone:864-674-5518
Mailing Address - Fax:864-674-1890
Practice Address - Street 1:350 NEW HOPE CHURCH RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29353-2325
Practice Address - Country:US
Practice Address - Phone:864-674-5518
Practice Address - Fax:864-674-1890
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC55504163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool