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NPI Code Detail

MEDICARE: MRS. KIMBERLY L. KOONTZ NP-C

MEDICARE: MRS. KIMBERLY L. KOONTZ NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209011642IL
2363LF0000XFamily Nurse Practitioner2023006444MO

General Provider Information

NPI Number : 1205235355
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY L. KOONTZ NP-C
Provider Business Mailing Address
First Line : 1615 JUNGERMANN RD
Second Line :
City : SAINT PETERS
State : MO
Zip : 63304-2821
Country : US
Telephone Number : 636-800-2157
Fax Number : 636-800-2159
Provider Business Practice Location Address
First Line : 1615 JUNGERMANN RD
Second Line :
City : SAINT PETERS
State : MO
Zip : 63304-2821
Country : US
Telephone Number : 636-800-2157
Fax Number : 636-800-2159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2014
Last Update Date : 06/21/2023

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