Basic Information
| Provider Information | |||||||||
| NPI: | 1497144620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | ALICE | ||||||||
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| Credential: | MSN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6330 S JONES BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891183302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026599090 | ||||||||
| FaxNumber: | 8668797229 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 W GERMANTOWN PIKE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | EAST NORRITON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194011385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102720190 | ||||||||
| FaxNumber: | 6102724428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2015 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP014555 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.