Provider Demographics
NPI:1497736003
Name:KLINK, KIMBERLY SHAWN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHAWN
Last Name:KLINK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 E DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-9327
Mailing Address - Country:US
Mailing Address - Phone:812-917-2169
Mailing Address - Fax:
Practice Address - Street 1:2828 E DAVIS DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-9327
Practice Address - Country:US
Practice Address - Phone:812-917-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001418A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000360964OtherANTHEM BLUE CROSS BLUE SH
IN200508910Medicaid
IN000000360964OtherANTHEM BLUE CROSS BLUE SH
IN200508910Medicaid