Individual
KIMBERLY VINYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1817 GRAVOIS RD, HIGH RIDGE, MO 63049-2668
(636) 376-0079
Mailing address
227 MAIN ST, FESTUS, MO 63028-1952
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
374700000X
Technician
Primary
—
—
Other
Enumeration date
06/02/2020
Last updated
07/12/2021
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