Provider Demographics
NPI:1386236958
Name:KIM, DALWINN DALE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DALWINN
Middle Name:DALE
Last Name:KIM
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 LYNNBROOK DR UNIT 1402
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2537
Mailing Address - Country:US
Mailing Address - Phone:210-660-0255
Mailing Address - Fax:
Practice Address - Street 1:5424 W US HIGHWAY 290 SERVICE ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735
Practice Address - Country:US
Practice Address - Phone:512-430-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX960899163WP0808X
TX1196224363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty