Healthcare Provider Details

I. General information

NPI: 1174373575
Provider Name (Legal Business Name): ASHLEY YENNY KIM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 GRIER DR STE C
LAS VEGAS NV
89119-3746
US

IV. Provider business mailing address

1181 GRIER DR STE C
LAS VEGAS NV
89119-3746
US

V. Phone/Fax

Practice location:
  • Phone: 888-888-9930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number870360
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: