Individual
KIMBERLY MICHELLE DALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1345 SMIZER MILL RD STE 1100, FENTON, MO 63026-7305
(636) 496-5023
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-7305
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2019038326
MO
Other
Enumeration date
10/08/2019
Last updated
06/18/2024
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