Provider Demographics
NPI:1295153898
Name:GARDNER, KIM BROWN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:BROWN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E JUNIOR HIGH RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-4419
Mailing Address - Country:US
Mailing Address - Phone:864-489-3176
Mailing Address - Fax:864-489-8534
Practice Address - Street 1:171 E JUNIOR HIGH RD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4419
Practice Address - Country:US
Practice Address - Phone:864-489-3176
Practice Address - Fax:864-489-8534
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85318163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool