Provider Demographics
NPI:1588183826
Name:JENNINGS, KIMBERLY JANE (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANE
Last Name:JENNINGS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 OLD TROLLEY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4957
Mailing Address - Country:US
Mailing Address - Phone:877-279-5960
Mailing Address - Fax:
Practice Address - Street 1:89 OLD TROLLEY RD STE 105
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-4957
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21393363LF0000X
NC5010048363LF0000X
SC109472163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine