Provider Demographics
NPI:1720092166
Name:MONNELL, KIMBERLY ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:MONNELL
Suffix:
Gender:F
Credentials:DO
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7162
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3980 HWY. 9 EAST
Practice Address - Street 2:STE 340
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8165
Practice Address - Country:US
Practice Address - Phone:843-390-8310
Practice Address - Fax:843-390-8319
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15492084N0400X
IN02004748A2084N0400X
LA3006492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201329690Medicaid
LA2409344Medicaid
IN000000971239OtherANTHEM
MS03688231Medicaid
LA2409344Medicaid
IN259370108Medicare PIN