Doctor Name: | MRS. SHANNON KIMSEY |
NPI Number: | 1023448073 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 209010918 |
Business Practice Address: | 2202 Essington Rd Suite 101 Joliet, IL - 604351634 |
Business Phone Number: | 8156765310 |
Business Fax Number: | |
Mailing Address: | 2202 Essington Rd, Suite 101 JOLIET |
State: | IL |
Postal Code: | 604351634 |
Phone Number: | 8156765310 |
Fax Number: | |
NPI Enumeration Date: | 11/12/2013 |
NPI Last Update Date: | 11/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209010918 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |