Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5005629 | NC |
NPI | 1033470687 |
---|---|
Provider Name | Christina Kim |
First Address | Durham, NC 27705-5547 |
Second Address | Durham, NC 27705-3934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 04/07/2016 |