Provider Demographics
NPI:1528655412
Name:IM, PATRICIA K
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:IM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 S EASTERN AVE STE 192
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2907
Mailing Address - Country:US
Mailing Address - Phone:725-232-1366
Mailing Address - Fax:702-478-2475
Practice Address - Street 1:8565 S EASTERN AVE STE 192
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2907
Practice Address - Country:US
Practice Address - Phone:725-232-1366
Practice Address - Fax:702-478-2475
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-25
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV836208363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner