Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shannon Marie Kimmel

Individual provider Family Nurse Practitioner · NPI 1104505890

Shannon Marie Kimmel is a Nurse Practitioner in Charlotte, North Carolina. Qualified in 2023, 3 years ago. Practices with Kinetic Medical Group, an 11-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
3
Licensed in
NC
In the registry since
2023
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Practice location Address checks out

9200 Glenwater Dr
Charlotte, NC 28262-8557
Phone: (901) 603-8704
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 5018442 (NC)

Record details

NPI number1104505890
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 12, 2023
Last updated in NPPESSeptember 26, 2025
Certification dateSeptember 26, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Kinetic Medical Group — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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