Healthcare Provider Details

I. General information

NPI: 1609001346
Provider Name (Legal Business Name): KIMBERLY BLAIR CALDWELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 80 BOX 10838
APO AP
96367-0011
US

IV. Provider business mailing address

PSC 80 BOX 10838
APO AP
96367-0011
US

V. Phone/Fax

Practice location:
  • Phone: 314-676-3141
  • Fax:
Mailing address:
  • Phone: 314-676-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101265832
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD16016
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: