Provider Demographics
NPI:1639840366
Name:GANN, KIMBERLY SHEA (APRN, FNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHEA
Last Name:GANN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARRISON PLZ
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35632-0002
Mailing Address - Country:US
Mailing Address - Phone:256-765-4667
Mailing Address - Fax:
Practice Address - Street 1:1 HARRISON PLZ
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35632-0002
Practice Address - Country:US
Practice Address - Phone:256-765-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30327363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care