Provider Demographics
NPI:1295300945
Name:HUMPHREYS, KYNDRA MARIE (RN)
Entity type:Individual
Prefix:
First Name:KYNDRA
Middle Name:MARIE
Last Name:HUMPHREYS
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 1:700 21ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-7400
Mailing Address - Country:US
Mailing Address - Phone:843-915-4836
Mailing Address - Fax:843-448-7499
Practice Address - Street 1:107 HIGHWAY 57 N
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7050
Practice Address - Country:US
Practice Address - Phone:843-915-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261563163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health