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NPI Code Detail

MEDICARE: VIDA ROSE KIM APRN, NP-C

MEDICARE: VIDA ROSE KIM APRN, NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAPRN001635NV

General Provider Information

NPI Number : 1386075117
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIDA ROSE KIM APRN, NP-C
Provider Business Mailing Address
First Line : 400 N STEPHANIE ST STE 300
Second Line :
City : HENDERSON
State : NV
Zip : 89014-6692
Country : US
Telephone Number : 702-952-3350
Fax Number : 702-952-3365
Provider Business Practice Location Address
First Line : 653 N TOWN CENTER DR STE 604
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-0520
Country : US
Telephone Number : 702-869-0855
Fax Number : 702-869-0859
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2013
Last Update Date : 05/13/2025

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Directions to “ VIDA ROSE KIM APRN, NP-C” Practice Location

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