Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 26NJ00062300 | NJ |
NPI | 1013005289 |
---|---|
Provider Name | Kim M Fallon |
First Address | Bayville, NJ 08721-1229 |
Second Address | Bayville, NJ 08721-1229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 11/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0192881 | (05) | NJ |