Provider Demographics
NPI:1366470940
Name:KIMBLE-HAAS, SHEILA LYNNE (CNM, CFNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:LYNNE
Last Name:KIMBLE-HAAS
Suffix:
Gender:F
Credentials:CNM, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 TONGASS AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5742
Mailing Address - Country:US
Mailing Address - Phone:907-228-4900
Mailing Address - Fax:800-852-3264
Practice Address - Street 1:2960 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5742
Practice Address - Country:US
Practice Address - Phone:907-228-4900
Practice Address - Fax:800-852-3264
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607019-1163W00000X
CO107645163WG0000X
NYF335771-1363LF0000X
NYF001331-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS19OPMedicaid
NM31005837Medicaid
AKHS19IPMedicaid
NM8HD611Medicare ID - Type Unspecified
AKHS19IPMedicaid
NMP66682Medicare UPIN
AK021310Medicare Oscar/Certification
NM31005837Medicaid