Healthcare Provider Details

I. General information

NPI: 1295694594
Provider Name (Legal Business Name): JENNIFER KIM JR. PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SATELLITE BLVD NW
SUWANEE GA
30024-4651
US

IV. Provider business mailing address

1325 SATELLITE BLVD NW
SUWANEE GA
30024-4651
US

V. Phone/Fax

Practice location:
  • Phone: 470-713-0414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP281429
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN281429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: