Provider Demographics
NPI:1699248633
Name:KIMES, SHARON MARIE DAVIDSON (APRN, FNP)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MARIE DAVIDSON
Last Name:KIMES
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:MR
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:KIMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:7781 E RIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-2487
Mailing Address - Country:US
Mailing Address - Phone:219-940-0005
Mailing Address - Fax:
Practice Address - Street 1:7781 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-2484
Practice Address - Country:US
Practice Address - Phone:219-940-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28145793A163W00000X
IN71008658A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse