Nicolet Kim Ryan, LISW-CP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8648 Issued in SC

Practice address

100 Sutter Dr
Suite 305
Surfside Beach, SC 29575-8665

Phone

(843) 855-0035

NPI assigned

Jul 14, 2006

Last updated

Oct 18, 2013By 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)

Enrolled

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382054400000",
    "number": "1235155052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31738",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295880029",
            "telephone_number": "843-855-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SUTTER DR",
            "address_2": "SUITE 305",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295758665",
            "telephone_number": "843-855-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "NICOLET",
        "middle_name": "KIM",
        "credential": "LISW-CP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2013-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "8648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jerry David Shepherd II, DDS
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• Jonathan Alan Simons, PHD

• Clinical Social Worker in Surfside Beach, SC
• Providers in Surfside Beach, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2013; 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.