Provider Demographics
NPI:1528816329
Name:MANLEY, KIMBERLY FAYE (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAYE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HUFF CREEK DIVE
Mailing Address - Street 2:
Mailing Address - City:PELZER
Mailing Address - State:SC
Mailing Address - Zip Code:29669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 HUFF CREEK DIVE
Practice Address - Street 2:
Practice Address - City:PELZER
Practice Address - State:SC
Practice Address - Zip Code:29669
Practice Address - Country:US
Practice Address - Phone:864-999-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC221525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse