Healthcare Provider Details

I. General information

NPI: 1528593142
Provider Name (Legal Business Name): KIM N HUNTER B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM NICOLE JERMANY

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 S WESTERN AVE STE A-21
OKLAHOMA CITY OK
73139-4982
US

IV. Provider business mailing address

5036 STAGECOACH WAY
GRAND PRAIRIE TX
75052-2438
US

V. Phone/Fax

Practice location:
  • Phone: 214-664-0837
  • Fax:
Mailing address:
  • Phone: 214-664-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: