Individual provider · Type 1 NPI

Shannon Marie Kimmel

Family Nurse Practitioner · Charlotte, NC

NPI number 1104505890 Active

Practice location

9200 Glenwater Dr
Charlotte, NC 28262-8557

Mailing address

6304 Durango Way
Denver, NC 28037-1429

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000X5018442 (NC)

Family Nurse Practitioner: Definition to come...

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About NPI 1104505890

Shannon Marie Kimmel's National Provider Identifier is 1104505890, issued on Jul 12, 2023. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Charlotte, NC. The record was last updated on Sep 26, 2025.