Healthcare Provider Details

I. General information

NPI: 1003516659
Provider Name (Legal Business Name): ANDREW ALEXANDER KIM JR. DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N STE 300
ST. PETERSBURG FL
33702
US

IV. Provider business mailing address

7901 4TH ST N STE 4000
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 478-321-7969
  • Fax:
Mailing address:
  • Phone: 478-321-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1214511
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN291818
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7844
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN291818
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: