Healthcare Provider Details

I. General information

NPI: 1326464884
Provider Name (Legal Business Name): KIM HOUSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM Y ROBERTS RN

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 PENNEY VIEW CT
NORTH LAS VEGAS NV
89032-6145
US

IV. Provider business mailing address

366 PENNEY VIEW CT
NORTH LAS VEGAS NV
89032-6145
US

V. Phone/Fax

Practice location:
  • Phone: 562-296-7929
  • Fax: 702-988-2622
Mailing address:
  • Phone: 562-296-7929
  • Fax: 702-988-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number58816
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number470371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: