Provider Demographics
NPI:1326464884
Name:HOUSTON, KIM (RN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:Y
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:366 PENNEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6145
Mailing Address - Country:US
Mailing Address - Phone:562-296-7929
Mailing Address - Fax:702-988-2622
Practice Address - Street 1:366 PENNEY VIEW CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6145
Practice Address - Country:US
Practice Address - Phone:562-296-7929
Practice Address - Fax:702-988-2622
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X
NV58816163WA0400X
CA470371261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health