Provider Demographics
NPI:1255708087
Name:SIMS, STEVEN KYLE (HIS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:KYLE
Last Name:SIMS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WILLIAM POPE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7502
Mailing Address - Country:US
Mailing Address - Phone:843-707-1305
Mailing Address - Fax:843-707-1311
Practice Address - Street 1:16 WILLIAM POPE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7502
Practice Address - Country:US
Practice Address - Phone:843-707-1305
Practice Address - Fax:843-707-1311
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0531174400000X
GAHADS-872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist