Provider Demographics
NPI:1861991994
Name:CAMPBELL, KIMBERLI LOUISE (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:LOUISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S WOODS MILL RD STE 580
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3513
Mailing Address - Country:US
Mailing Address - Phone:314-205-6736
Mailing Address - Fax:314-576-2319
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3406
Practice Address - Country:US
Practice Address - Phone:314-205-6736
Practice Address - Fax:314-576-2319
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018003489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily