Healthcare Provider Details

I. General information

NPI: 1205172301
Provider Name (Legal Business Name): KIMBERLY SHAN ADAMS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 07/12/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRUMAN VA HOSPITAL 800 HOSPITAL DR.
COLUMBIA MO
65201
US

IV. Provider business mailing address

800 HOSPITAL DR
COLUMBIA MO
65201-5275
US

V. Phone/Fax

Practice location:
  • Phone: 573-814-6000
  • Fax: 573-814-6194
Mailing address:
  • Phone: 573-881-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2012036766
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: