Provider Demographics
NPI:1902494768
Name:KIM, LAUREN (FNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HALL DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-256-8561
Mailing Address - Fax:866-644-0869
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:866-644-0869
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2299719363LF0000X
MAMCS004262B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily