Provider Demographics
NPI:1962556167
Name:PAULSON, KIM (RNFA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:PAULSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N COLLEGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3382
Mailing Address - Country:US
Mailing Address - Phone:208-734-7291
Mailing Address - Fax:208-734-7294
Practice Address - Street 1:714 N COLLEGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3382
Practice Address - Country:US
Practice Address - Phone:208-734-7291
Practice Address - Fax:208-734-7294
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN18813163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN18813OtherNURSING LICENSE