Provider Demographics
NPI:1184431132
Name:UPTON, KIM MICHELLE
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MICHELLE
Last Name:UPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SPRING VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-6634
Mailing Address - Country:US
Mailing Address - Phone:310-405-2309
Mailing Address - Fax:
Practice Address - Street 1:550 SPRING VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815-6634
Practice Address - Country:US
Practice Address - Phone:310-405-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care