Individual
MRS. KIMBERLY MARIE WICKLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
15945 CLAYTON RD STE 340, BALLWIN, MO 63011-2492
(636) 256-5130
Mailing address
15945 CLAYTON RD STE 340, BALLWIN, MO 63011-2492
(636) 256-5130
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2021043381
MO
Other
Enumeration date
11/19/2021
Last updated
02/08/2022
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