Provider Demographics
NPI:1538452479
Name:KIM, DEBORAH (APRN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 E SOUTH TEMPLE
Mailing Address - Street 2:STE# 101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1339
Mailing Address - Country:US
Mailing Address - Phone:801-746-0776
Mailing Address - Fax:801-746-0775
Practice Address - Street 1:807 E SOUTH TEMPLE
Practice Address - Street 2:STE# 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1339
Practice Address - Country:US
Practice Address - Phone:801-746-0776
Practice Address - Fax:801-746-0775
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT220582-9938364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist