Basic Information
| Provider Information | |||||||||
| NPI: | 1891021416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIMMIN | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 747 | ||||||||
| Address2: | KH FAMILY HEALTH CLINIC | ||||||||
| City: | KEWANEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614430747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098527700 | ||||||||
| FaxNumber: | 3098527764 | ||||||||
| Practice Location | |||||||||
| Address1: | 1051 W SOUTH ST | ||||||||
| Address2: | KH FAMILY HEALTH CLINIC | ||||||||
| City: | KEWANEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614438354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098527700 | ||||||||
| FaxNumber: | 3098527764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2009 | ||||||||
| LastUpdateDate: | 04/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209007870 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.