Healthcare Provider Details

I. General information

NPI: 1962087304
Provider Name (Legal Business Name): KIMBERLY M SHROYER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CHRISTIE AVE
ANNA OH
45302-8614
US

IV. Provider business mailing address

3170 KETTERING BLVD BUILDING B 3RD FLOOR
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-489-3748
  • Fax:
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: