Provider Demographics
NPI:1306251277
Name:KINSEY, LAUREN SMOAK (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:SMOAK
Last Name:KINSEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8423 OLD STATE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059
Mailing Address - Country:US
Mailing Address - Phone:803-759-3014
Mailing Address - Fax:
Practice Address - Street 1:932 HOLLY ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059-2762
Practice Address - Country:US
Practice Address - Phone:803-759-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45055164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse