Individual
MRS. KIMBERLY BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
670 PIERCE BLVD, O FALLON, IL 62269-2579
(618) 206-2094
Mailing address
670 PIERCE BLVD, O FALLON, IL 62269-2579
(618) 206-2094
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209015757
IL
Other
Enumeration date
04/18/2017
Last updated
12/29/2021
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