MEDICARE: MRS. KIMBERLY CHRISTINE GORMAN PNP

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
1	363LP0200X	Pediatric Nurse Practitioner	2025045770	MO
2	363LA2100X	Acute Care Nurse Practitioner	2025045770	MO

General Provider Information

NPI Number	:	1689543308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY CHRISTINE GORMAN PNP

Provider Business Mailing Address
First Line	:	1 CHILDRENS PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CHILDRENS PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	03/18/2026

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