Provider Demographics
NPI:1083979538
Name:HUNT, SHIMEA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHIMEA
Middle Name:LYNN
Last Name:HUNT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 LAKESHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1561
Mailing Address - Country:US
Mailing Address - Phone:517-265-0600
Mailing Address - Fax:517-263-0024
Practice Address - Street 1:781 LAKESHIRE TRL
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-265-0600
Practice Address - Fax:517-263-0024
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1083979538Medicaid