Individual
KRISTINE NICHOLE MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
6129 CORDERO DR, CICERO, NY 13039-7813
(315) 276-9936
Mailing address
6129 CORDERO DR, CICERO, NY 13039-7813
(315) 276-9936
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403546
NY
Other
Enumeration date
06/29/2021
Last updated
06/29/2021
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