Provider Demographics
NPI:1912568825
Name:MYERS, KIM A (FNP, AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:A
Last Name:MYERS
Suffix:
Gender:F
Credentials:FNP, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 VINERIDGE RUN APT 205
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1769
Mailing Address - Country:US
Mailing Address - Phone:407-821-5878
Mailing Address - Fax:
Practice Address - Street 1:976 VINERIDGE RUN APT 205
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-1769
Practice Address - Country:US
Practice Address - Phone:407-821-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9258928163W00000X
FLAPRN11004488363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse