Provider Demographics
NPI:1699593939
Name:KIMMONS, SHANIA
Entity type:Individual
Prefix:MISS
First Name:SHANIA
Middle Name:
Last Name:KIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 CHISSOM TRL
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2309
Mailing Address - Country:US
Mailing Address - Phone:810-820-7648
Mailing Address - Fax:810-820-7648
Practice Address - Street 1:1367 CHISSOM TRL
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2309
Practice Address - Country:US
Practice Address - Phone:810-820-7648
Practice Address - Fax:810-820-7648
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker