Kimberly Thomas Gaughan, BSN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

39545 Issued in SC

Practice address

700 21St Ave N
Myrtle Beach, SC 29577-7400

Phone

(843) 409-5287

NPI assigned

Jan 22, 2020

Last updated

Jan 22, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1194355701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2203 WOODLAWN DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295267707",
            "telephone_number": "843-409-5287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 21ST AVE N",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295777400",
            "telephone_number": "843-409-5287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUGHAN",
        "first_name": "KIMBERLY",
        "middle_name": "THOMAS",
        "name_prefix": "Mrs.",
        "credential": "BSN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-22",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "39545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Registered Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.