KIMBERLY ANN SHEA
NPI 1477264026
Physician Assistant - Medical in Ellsworth Afb, SD

Q: What is Kimberly Shea's NPI number?

The NPI number for Kimberly Shea is 1477264026. It was assigned to this individual provider in the NPPES registry on December 5, 2022. The provider is also known as Kimberly Ann Wallace.

Q: What is Kimberly Shea's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Kimberly Shea was last updated on December 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 05, 2022PECOS EnrolledAccepts Medicare Assignment

2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706(605) 385-3111(605) 385-3620 Get Directions Write a Review

NPPES record last updated: December 17, 2025. Verified against the NPPES registry weekly; last sync: September 27, 2026.

Record update history: Dec 17, 2025, Dec 9, 2022 (2 updates tracked since 2022).

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About Kimberly Ann Shea NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY ANN SHEA (NPI 1477264026) is an individual medical provider in Ellsworth Afb, South Dakota and active in the NPI registry since December 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1477264026

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameKIMBERLY ANN SHEA

Location Address2900 DOOLITTLE DREllsworth Afb, SD 57706-4821

Mailing Address2900 Doolittle DrEllsworth Afb, SD 57706-4821 · (605) 385-3111 · Fax (605) 385-3620

Phone(605) 385-3111

Fax(605) 385-3620

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateDecember 5, 2022

Last NPPES UpdateDecember 17, 20252 updates tracked since enumeration

NPPES CertifiedDecember 17, 2025

✔ NPI 1477264026 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

Also ListedMilitary Health Care ProviderTaxonomy 171000000X

2900 DOOLITTLE DR, Ellsworth Afb, SD 57706

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Other Names 1

Former Name (1)Kimberly Ann Wallace

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kimberly Ann Shea is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4880183581

PECOS Enrollment IDI20251031003197

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. CHRISTLE CELESTE USERA MSW/CSW-PIP

Social Worker (Clinical)