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General NPI Number Information
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NPI Number | 1386075117
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Entity Type | Individual
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Provider Name | VIDA ROSE KIM APRN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 653 N TOWN CENTER DR STE 604
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City | LAS VEGAS
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State | NV
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Zip | 89144-0520
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Country | US
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Telephone | 702-869-0855
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Fax | 702-869-0859
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Provider Business Mailing Address
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Address Line | 400 N STEPHANIE ST STE 300
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City | HENDERSON
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State | NV
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Zip | 89014-6692
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Country | US
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Telephone | 702-952-3350
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Fax | 702-952-3365
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN001635
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License Number State | NV
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