Individual
MS. KIMBERLY LYNN TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
3737 N KINGSHIGHWAY BLVD, STE 209, SAINT LOUIS, MO 63115-1736
(314) 261-5250
(314) 261-4567
Mailing address
PO BOX 7412039, CHICAGO, IL 60674-2039
(314) 261-5250
(314) 261-4567
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2019018502
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420078075
—
MO
Enumeration date
06/18/2019
Last updated
04/17/2025
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