1467854042 NPI number — KIMBERLY C. SHAW FNP-BC

Table of content: KIMBERLY C. SHAW FNP-BC (NPI 1467854042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467854042 NPI number — KIMBERLY C. SHAW FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
KIMBERLY
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467854042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1257
Provider Second Line Business Mailing Address:
6500 HOSPITAL DRIVE
Provider Business Mailing Address City Name:
HANNIBAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63401-1257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-406-5888
Provider Business Mailing Address Fax Number:
573-406-5889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 HOSPITAL DR
Provider Second Line Business Practice Location Address:
FAMILY MEDICINE
Provider Business Practice Location Address City Name:
HANNIBAL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63401-6890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-629-3400
Provider Business Practice Location Address Fax Number:
573-629-3414
Provider Enumeration Date:
09/25/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  146869 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 041359642 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2014037315 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)