Provider Demographics
NPI:1497144620
Name:KIM, ALICE (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 MILL ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1320
Mailing Address - Country:US
Mailing Address - Phone:775-398-1980
Mailing Address - Fax:775-398-1981
Practice Address - Street 1:781 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1320
Practice Address - Country:US
Practice Address - Phone:775-398-1980
Practice Address - Fax:775-398-1981
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014555363LF0000X
NV820119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily