Individual
KIRK WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4483 DUNCAN AVE, SAINT LOUIS, MO 63110-1111
(314) 454-7055
Mailing address
7 COTTONWOOD GLEN DR, GLEN CARBON, IL 62034-3011
(618) 843-6911
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
2019021082
MO
Other
Enumeration date
02/26/2024
Last updated
02/26/2024
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