Shortner, Kimberly Maria

Shortner, Kimberly Maria is an individual health care provider with primary practice located at 9532 E. 16 Frontage Rd. Ste. 100, Onalaska WI 54650-6742. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Shortner, Kimberly Maria can be contacted via phone (608) 783-0506.

Contact Information

Primary practice address
9532 E. 16 Frontage Rd. Ste. 100 Onalaska WI 54650-6742
Phone: (608) 783-0506
Fax: (608) 783-0242
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 18207-130 Wisconsin

Profile Details

NPI number 1063938595
LBN Legal business name Shortner, Kimberly Maria
Credentials SAC-IT
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2017
Last updated Aug 16th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063938595 NPPES
Wisconsin MEDICAID 1003150004

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