Provider Demographics
NPI:1962087304
Name:SHROYER, KIMBERLY M (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:M
Last Name:SHROYER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3170 KETTERING BLVD
Mailing Address - Street 2:BUILDING B 3RD FLOOR
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:305 CHRISTIE AVE
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:OH
Practice Address - Zip Code:45302-8614
Practice Address - Country:US
Practice Address - Phone:937-489-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily