Individual
KIMBERLY BRAXTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
79 CHARBONIER BLUFFS DR, FLORISSANT, MO 63031-5652
(314) 837-6113
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2012038030
MO
Other
Enumeration date
04/03/2014
Last updated
04/03/2014
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