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General NPI Number Information
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NPI Number | 1770380602
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Entity Type | Organization
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Legal Business Name | BETHESDA MEDICINE
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 1451 WALKER WAY
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City | CORALVILLE
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State | IA
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Zip | 52241-3032
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Country | US
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Telephone | 319-333-8244
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Fax |
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Provider Business Mailing Address
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Address Line | 6625 CHAMBREL WAY
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City | SUWANEE
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State | GA
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Zip | 30024-5415
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Country | US
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Telephone | 319-333-8244
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | JIYEON KIM
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Credential | NP
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Telephone | 319-333-9244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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