Healthcare Provider Details
I. General information
NPI: 1962853986
Provider Name (Legal Business Name): KIMBER GUINN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/30/2016
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US
IV. Provider business mailing address
54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US
V. Phone/Fax
- Phone: 573-348-8000
- Fax: 573-302-2297
- Phone: 573-348-8000
- Fax: 573-302-2297
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 2019015005 |
| License Number State | MO |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: