Provider Demographics
NPI:1841185287
Name:SHOEMAKER-THOMPSON, KIMBERLEE (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:SHOEMAKER-THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:ELAINE
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-4200
Mailing Address - Fax:814-375-4232
Practice Address - Street 1:145 HOSPITAL AVE STE 315
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1465
Practice Address - Country:US
Practice Address - Phone:814-503-4305
Practice Address - Fax:814-503-4307
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT024252207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine