Provider Demographics
NPI:1982906020
Name:KIM, MISOOK (FNP)
Entity Type:Individual
Prefix:MS
First Name:MISOOK
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4545 POST OAK PLACE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3164
Mailing Address - Country:US
Mailing Address - Phone:713-960-8008
Mailing Address - Fax:713-960-0965
Practice Address - Street 1:4545 POST OAK PLACE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3164
Practice Address - Country:US
Practice Address - Phone:713-960-8008
Practice Address - Fax:713-960-0965
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDQ5280OtherMEDICARE RR PALMETTO
TX2823866-01Medicaid
TXP00947788OtherPALMETTO RR
TX0016SHOtherBCBS OF TEXAS
TXDO7564OtherRR PALMETTO
TX862N93OtherBCBS OF TEXAS
TXDO7564OtherRR PALMETTO