Provider Demographics
NPI:1073031902
Name:MARENAKOS, KIMBI GLENN (FNP-C)
Entity type:Individual
Prefix:DR
First Name:KIMBI
Middle Name:GLENN
Last Name:MARENAKOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7165
Mailing Address - Country:US
Mailing Address - Phone:843-608-0158
Mailing Address - Fax:877-385-2198
Practice Address - Street 1:655 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7165
Practice Address - Country:US
Practice Address - Phone:843-608-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21265363LF0000X
SC4764101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101Y00000XBehavioral Health & Social Service ProvidersCounselor