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General NPI Number Information
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NPI Number | 1801468921
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Entity Type | Individual
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Provider Name | KIMBERLY SHAY
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Gender | Female
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 07/16/2021
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Provider Practice Location Address
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Address Line | 920 W HWY 46
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City | SPENCER
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State | IN
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Zip | 47460
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Country | US
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Telephone | 812-585-1629
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Fax |
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Provider Business Mailing Address
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Address Line | 4788 BRAYSVILLE RD
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City | SPENCER
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State | IN
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Zip | 47460-5040
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Country | US
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Telephone | 812-585-1629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SL0600X
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Taxonomy Name | Long-Term Care Clinical Nurse Specialist
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License Number | 28240430A
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License Number State | IN
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