Individual
MIRA KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
720 1ST TER, LANSING, KS 66043-1704
(913) 682-5588
(913) 682-2698
Mailing address
12413 W 100TH PL, LENEXA, KS 66215-1929
(913) 492-3484
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
53-74979-072
KS
Other
Enumeration date
10/13/2009
Last updated
10/13/2009
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