Provider Demographics
NPI:1912590274
Name:KIM, HYUNAH MELANIE (BSN, MSN, FNP)
Entity type:Individual
Prefix:MS
First Name:HYUNAH
Middle Name:MELANIE
Last Name:KIM
Suffix:
Gender:F
Credentials:BSN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 LINCOLN STREET, UNIT A
Mailing Address - Street 2:UNIT A
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650
Mailing Address - Country:US
Mailing Address - Phone:865-621-4424
Mailing Address - Fax:
Practice Address - Street 1:466 LINCOLN STREET, UNIT A
Practice Address - Street 2:UNIT A
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-0765
Practice Address - Country:US
Practice Address - Phone:865-621-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16621500163WM0705X
NJ26NJ01281900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical