Kimberly Suzanne Demichele, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

44320 Issued in SC

Practice address

721 Wappoo Rd
Charleston, SC 29407-5861

Phone

(843) 813-7703

NPI assigned

Jul 2, 2019

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pattisons D R E a M Academy

  • Rehabilitation Clinic/Center
  • Charleston, SC
  • NPI 1861678534
  NPD (past)

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1285296988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1962 OAK TREE LN",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294649413",
            "telephone_number": "843-607-7138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 WAPPOO RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075861",
            "telephone_number": "843-813-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMICHELE",
        "first_name": "KIMBERLY",
        "middle_name": "SUZANNE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-02",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "SC",
            "license": "44320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861678534",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Charleston",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "721 Wappoo Rd",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294075861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Delta of Charleston, Inc
• Tina Deluca, M.A., CCC-SLP, M.ED.
• Cheri Jan Demarchi, LISW-CP
• Matthew Thomas Demarco, MD
• Stetson Taylor Demartino, DPM
• Nancy K Demore, MD
• Harry A Demos, MD
• Angela Dempsey-Fanning, M.D.
• Angela P Dempsey, RD, LD
• Jared Presley Dempsey, M.A.

• Licensed Practical Nurse in Charleston, SC
• Providers in Charleston, SC by specialty
• Licensed Practical Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; 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.