Healthcare Provider Details

I. General information

NPI: 1518787308
Provider Name (Legal Business Name): KIMBERLY M REINBOLD CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD DES PERES RD STE 150
DES PERES MO
63131-1874
US

IV. Provider business mailing address

9910 GREEN PARK RD
SAINT LOUIS MO
63123-6144
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2918
  • Fax:
Mailing address:
  • Phone: 314-565-8419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: