Basic Information
| Provider Information | |||||||||
| NPI: | 1548694714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIZER | ||||||||
| FirstName: | CARMAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1624 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037262350 | ||||||||
| FaxNumber: | 8037539102 | ||||||||
| Practice Location | |||||||||
| Address1: | 1326 EBENEZER RD | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297322337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004910909 | ||||||||
| FaxNumber: | 8433532581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2013 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 220032 | NC | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 18463 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | NP2582 | 05 | SC | MEDICAID |