Provider Demographics
NPI:1780169037
Name:SHIELDS, KATHLEEN KIMBROUGH (CRNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KIMBROUGH
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:057-319-7012
Mailing Address - Fax:057-319-7892
Practice Address - Street 1:1201 11TH AVE S STE 305
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3422
Practice Address - Country:US
Practice Address - Phone:205-996-2770
Practice Address - Fax:205-996-2733
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-153586363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology