Individual
KIM MARIE WATERHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1101 HIGHWAY K, O FALLON, MO 63366-8431
(636) 379-6363
(636) 379-1297
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
2009005694
MO
208000000X
Pediatrics Physician
2009005694
MO
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
2009005694
MO
Other
Enumeration date
06/15/2007
Last updated
08/28/2025
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