Kim Annette Lukridge, RN
Individual provider Active NPI Registered Nurse · Roebuck, SC
NPI 1629410394 · NPPES record last updated Jul 23, 2013
Key facts
- NPI
- 1629410394
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 34047 (SC)
- Practice address
- 1050 Cavalier Way
Roebuck, SC 29376-3364 - Phone
- (864) 582-4347
- Fax
- (864) 587-8738
- NPI assigned
- Jul 23, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34047 | SC | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 34047 | SC | Yes |
Addresses
Primary practice location
1050 Cavalier Way
Roebuck, SC 29376-3364
Mailing address
1050 Cavalier Way
Roebuck, SC 29376-3364
Phone (864) 582-4347
Other providers in Roebuck, SC
- Divya Somaya Kulkarni
- Brandy Dover Laney
- Jennifer Wren Lever
- Joseph Kayne Lever
- Susan S Lueck
- Alison Markey
- Mary Black Physicians Group LLC
- Mary Black Physicians Group LLC
- Mary Black Physicians Group, LLC
- Latoya McBeth
All providers in Roebuck, SC · Registered Nurse in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.