Healthcare Provider Details

I. General information

NPI: 1396582375
Provider Name (Legal Business Name): KIM ALICIA MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE RM 6006
MIAMI FL
33136-1005
US

IV. Provider business mailing address

13368 NW 2ND CT UNIT 303
PLANTATION FL
33325-7671
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6042
  • Fax: 305-325-0293
Mailing address:
  • Phone: 786-939-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number41038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: