Healthcare Provider Details

I. General information

NPI: 1760309439
Provider Name (Legal Business Name): KIMBERLY L SKUPSKI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N 1200 W
MIDDLEBURY IN
46540-9372
US

IV. Provider business mailing address

51302 SHANNON BROOK CT
GRANGER IN
46530-7906
US

V. Phone/Fax

Practice location:
  • Phone: 574-825-3888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28245253A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: