Provider Demographics
NPI:1215265251
Name:JAMES, KIM ANGEL
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:ANGEL
Last Name:JAMES
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 1:11134 FARMERS BLVD
Mailing Address - Street 2:ST. ALBANS
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2328
Mailing Address - Country:US
Mailing Address - Phone:718-454-1466
Mailing Address - Fax:718-554-7123
Practice Address - Street 1:11134 FARMERS BLVD
Practice Address - Street 2:ST. ALBANS
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2328
Practice Address - Country:US
Practice Address - Phone:718-454-1466
Practice Address - Fax:718-554-7123
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily