Provider Demographics
NPI:1740254119
Name:SHIMP, KRISTEN E (CRNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:SHIMP
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3335
Mailing Address - Country:US
Mailing Address - Phone:610-372-8044
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:301 PENN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1264
Practice Address - Country:US
Practice Address - Phone:610-898-7560
Practice Address - Fax:610-898-7561
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003904363LF0000X
PASP008030363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075191Medicare PIN