Provider Demographics
NPI:1043616444
Name:RASMUSSEN, KIM (APRN-C)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 N VALDOSTA RD
Mailing Address - Street 2:B
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3321 N VALDOSTA RD
Practice Address - Street 2:B
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1459
Practice Address - Country:US
Practice Address - Phone:229-242-9310
Practice Address - Fax:229-242-9714
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily