Provider Demographics
NPI:1992942502
Name:KYKER, KIMBERLY GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:GAIL
Last Name:KYKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-7257
Mailing Address - Fax:864-654-7672
Practice Address - Street 1:100 HEALTHY WAY STE 1200
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7916
Practice Address - Country:US
Practice Address - Phone:864-512-6140
Practice Address - Fax:864-512-6149
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31408207Q00000X, 207P00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC314083Medicaid
SCAA82447043Medicare PIN