Jackson, Kimberly Shelley
Jackson, Kimberly Shelley is an individual health care provider with primary practice located at 864 Island Park Dr Ste 101 , Daniel Island SC 29492-7446. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jackson, Kimberly Shelley can be contacted via phone (843) 876-7975.Contact Information
Primary practice address
864 Island Park Dr Ste 101
Daniel Island SC 29492-7446
Phone: (843) 876-7975
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 18009 | South Carolina |
Profile Details
| NPI number | 1558318527 |
|---|---|
| LBN Legal business name | Jackson, Kimberly Shelley |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 27th, 2006 |
| Last updated | Jan 23rd, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558318527 | NPPES |
| South Carolina | MEDICAID | T19753 |
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