| Doctor Name: | KIM MARIE MLCAK |
| NPI Number: | 1124323456 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | GNP |
| License Number: | 244803 |
| Business Practice Address: | 680 Fm 517 Rd W Dickinson, TX - 775393904 |
| Business Phone Number: | 2812187200 |
| Business Fax Number: | 2812187203 |
| Mailing Address: | 680 Fm 517 Rd W, DICKINSON |
| State: | TX |
| Postal Code: | 775393904 |
| Phone Number: | 2812187200 |
| Fax Number: | 2812187203 |
| NPI Enumeration Date: | 01/18/2011 |
| NPI Last Update Date: | 06/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 244803 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |