Healthcare Provider Details

I. General information

NPI: 1740254119
Provider Name (Legal Business Name): KRISTEN E SHIMP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PENN AVE SUITE 200
WEST READING PA
19611-1264
US

IV. Provider business mailing address

50 COMMERCE DR
WYOMISSING PA
19610-3335
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-7560
  • Fax: 610-898-7561
Mailing address:
  • Phone: 610-372-8044
  • Fax: 484-334-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5003904
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP008030
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: