Healthcare Provider Details

I. General information

NPI: 1639873581
Provider Name (Legal Business Name): KIMBERLEY RAE TEMPLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD STE 220
SAINT LOUIS MO
63124-2056
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-3531
  • Fax: 888-822-0631
Mailing address:
  • Phone: 314-996-3531
  • Fax: 314-644-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM08339
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number2023011623
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: