Individual
MS. KIMBERLY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LRN
Contact information
Practice address
925 HIGHWAY V V, KENNETT, MO 63857
(573) 888-5925
(573) 888-9365
Mailing address
500 US HIGHWAY 61 NORTH, HAYTI, MO 63851
(573) 359-2600
(573) 359-1103
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2007032845
MO
Other
Enumeration date
02/18/2010
Last updated
02/18/2010
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