Healthcare Provider Details

I. General information

NPI: 1912997958
Provider Name (Legal Business Name): KIM PATRICIA MIHELICH F.N.P.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE 5TH FLOOR
DALLAS TX
75203-1201
US

IV. Provider business mailing address

1441 N BECKLEY AVE 5TH FLOOR
DALLAS TX
75203-1201
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-1837
  • Fax: 214-947-1851
Mailing address:
  • Phone: 214-947-1837
  • Fax: 214-947-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number250339
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: