Healthcare Provider Details

I. General information

NPI: 1306053087
Provider Name (Legal Business Name): KIMBERLY A COLEMAN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N BALLAS RD STE 600D
SAINT LOUIS MO
63131-2332
US

IV. Provider business mailing address

3023 N BALLAS RD STE 600D
SAINT LOUIS MO
63131-2332
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-4880
  • Fax:
Mailing address:
  • Phone: 314-996-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number132083
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: