Healthcare Provider Details

I. General information

NPI: 1497425862
Provider Name (Legal Business Name): KIMBERLY ANNE DARCY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEW HOSP PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

5659 POTOMAC ST
SAINT LOUIS MO
63139-1507
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-3000
  • Fax:
Mailing address:
  • Phone: 314-913-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG07210175
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: