MEDICARE: MRS. BETSEY K KIM MSN, CPNP

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
1	163WP0200X	Pediatric Registered Nurse	RN353978L	PA
2	363LP0200X	Pediatric Nurse Practitioner	SP007326	PA

General Provider Information

NPI Number	:	1649260175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETSEY K KIM MSN, CPNP

Provider Business Mailing Address
First Line	:	607 WHITPAIN HLS
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-1348
Country	:	US
Telephone Number	:	610-277-0554
Fax Number	:

Provider Business Practice Location Address
First Line	:	34TH STREET & CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104
Country	:	US
Telephone Number	:	215-590-3440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	09/11/2025

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