Provider Demographics
NPI:1609845759
Name:KIM, JANUARY J (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JANUARY
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JANUARY
Other - Middle Name:J
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1441 29TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1309
Mailing Address - Country:US
Mailing Address - Phone:515-985-2024
Mailing Address - Fax:515-985-2025
Practice Address - Street 1:1441 29TH ST STE 305
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1309
Practice Address - Country:US
Practice Address - Phone:515-985-2024
Practice Address - Fax:515-985-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083414163WP0807X
IAT083414363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0132OtherJOHN DEERE HC
IA43845OtherBLUE SHIELD
IA1045898Medicaid
IA1045898Medicaid