Individual
KIMBERLY BONVILLAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
20 PROGRESS POINT PKWY STE 108, O FALLON, MO 63368-2207
(636) 344-2400
(636) 344-2401
Mailing address
PO BOX 959354, SAINT LOUIS, MO 63195-9354
(636) 344-2400
(636) 344-2401
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2026019751
MO
363L00000X
Nurse Practitioner
APRN.CNP.0035357
OH
363LF0000X
Family Nurse Practitioner
35357
OH
363LF0000X
Family Nurse Practitioner
4008581
KY
Other
Enumeration date
04/24/2011
Last updated
06/11/2026
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