Provider Demographics
NPI:1881866937
Name:NTEKIM, KATHERINE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:NTEKIM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19461 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3255
Mailing Address - Country:US
Mailing Address - Phone:954-554-0569
Mailing Address - Fax:305-225-9011
Practice Address - Street 1:8250 SW 40TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3335
Practice Address - Country:US
Practice Address - Phone:954-554-0569
Practice Address - Fax:305-225-9011
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2008392364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7454WMedicare PIN
FLS68175Medicare UPIN