=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841105335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY HEALTH & FOOT CARE CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2026
-----------------------------------------------------
Last Update Date | 08/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 708 W MAIN ST STE A
-----------------------------------------------------
City | BLOOMFIELD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47424-1178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-227-7432
-----------------------------------------------------
Fax | 812-227-3647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 708 W MAIN ST STE A
-----------------------------------------------------
City | BLOOMFIELD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47424-1178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-227-7432
-----------------------------------------------------
Fax | 812-227-3647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTITIONER
-----------------------------------------------------
Name | SHANNA KAY KLUN
-----------------------------------------------------
Credential | NP-C
-----------------------------------------------------
Telephone | 812-227-7432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------