Healthcare Provider Details

I. General information

NPI: 1699248633
Provider Name (Legal Business Name): SHARON MARIE DAVIDSON KIMES APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON MARIE KIMES APRN, FNP

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 US HIGHWAY 6 STE 195
PORTAGE IN
46368-5057
US

IV. Provider business mailing address

3815 RIVER CROSSING PKWY STE 100
INDIANAPOLIS IN
46240-7766
US

V. Phone/Fax

Practice location:
  • Phone: 219-513-3701
  • Fax:
Mailing address:
  • Phone: 844-735-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008658A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28145793A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: