Provider Demographics
NPI:1144536400
Name:KIM, ELAINE I (MSN-FNP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:I
Last Name:KIM
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD STE 536
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8137
Mailing Address - Country:US
Mailing Address - Phone:972-378-9560
Mailing Address - Fax:844-290-4363
Practice Address - Street 1:6124 W PARKER RD STE 536
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8137
Practice Address - Country:US
Practice Address - Phone:972-378-9560
Practice Address - Fax:844-290-4363
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217423701Medicaid
TXTXB111756Medicare PIN
TXP01074827Medicare PIN