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General NPI Number Information
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NPI Number | 1528726221
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Entity Type | Individual
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Provider Name | MS. JISOOK KIM
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Gender | Female
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 6701 FM 119
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City | SUNRAY
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State | TX
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Zip | 79086-2013
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Country | US
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Telephone | 806-935-1503
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Fax | 806-935-1429
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Provider Business Mailing Address
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Address Line | PO BOX 195
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City | DUMAS
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State | TX
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Zip | 79029-0195
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Country | US
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Telephone | 817-372-4194
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 1059809
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License Number State | TX
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