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NPI Code Detail

MEDICARE: KIMBERLY SHAW FNP

MEDICARE: KIMBERLY SHAW FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner2024046003MO
2363LF0000XFamily Nurse PractitionerAPRN11036441FL
3363LF0000XFamily Nurse PractitionerAPRN-4940HI
4363LF0000XFamily Nurse Practitioner5021135NC
5363LF0000XFamily Nurse Practitioner71017357AIN
6363LF0000XFamily Nurse Practitioner116558NE
7363LF0000XFamily Nurse PractitionerSP033294PA
8363LF0000XFamily Nurse Practitioner904933MS
9363LF0000XFamily Nurse PractitionerGAA-NP005163GA
10363LF0000XFamily Nurse Practitioner232090AR
11363LF0000XFamily Nurse Practitioner1196432TX
12363LF0000XFamily Nurse Practitioner0037972OH
13363LF0000XFamily Nurse Practitioner86157NM
14363LF0000XFamily Nurse Practitioner37681TN

General Provider Information

NPI Number : 1265104095
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY SHAW FNP
Provider Business Mailing Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number :
Provider Business Practice Location Address
First Line : 232 MARKET ST
Second Line :
City : FLOWOOD
State : MS
Zip : 39232-3339
Country : US
Telephone Number : 866-849-0692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2021
Last Update Date : 05/21/2026

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