Provider Demographics
NPI:1801174164
Name:KIMBALL, SHARILYN SUE (NP)
Entity type:Individual
Prefix:
First Name:SHARILYN
Middle Name:SUE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 S UNION PARK AVE APT A409
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3023
Mailing Address - Country:US
Mailing Address - Phone:801-368-2160
Mailing Address - Fax:
Practice Address - Street 1:2901 W BLUE GRASS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4190
Practice Address - Country:US
Practice Address - Phone:801-368-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT281140-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily