Provider Demographics
NPI:1023448073
Name:KIMSEY, SHANNON (FPA, APRN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:KIMSEY
Suffix:
Gender:F
Credentials:FPA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N MICHIGAN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7605
Mailing Address - Country:US
Mailing Address - Phone:312-263-4625
Mailing Address - Fax:312-263-5029
Practice Address - Street 1:150 N MICHIGAN AVE STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7605
Practice Address - Country:US
Practice Address - Phone:312-263-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily