Individual
JEONG KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4906
(817) 250-1815
Mailing address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4906
(817) 250-1815
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP127743
TX
363LG0600X
Gerontology Nurse Practitioner
AP127743
TX
363LP2300X
Primary Care Nurse Practitioner
AP127743
TX
Other
Enumeration date
05/05/2015
Last updated
04/02/2019
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