Kimberly Michelle Daller, FNP-BC
Nurse Practitioner, Family in Fenton, MO. Individual provider (NPI-1).
NPI number1164064440
StatusActive
Last updated in NPPESJun 18, 2024
Details
- NPI
- 1164064440
- Entity type
- Individual (NPI-1)
- Name
- Kimberly Michelle Daller
- Credential
- FNP-BC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 8, 2019
- Certification date
- Jun 18, 2024
- Last updated
- Jun 18, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 2019038326 | MO | Yes |
Other names
- Kimberly Michelle Emery (Former Name)
Practice location
1345 Smizer Mill Rd Ste 1100Fenton, MO 63026-7305
Phone 636-496-5023
Mailing address
Po Box 955534Saint Louis, MO 63195-7305
Other practice locations
1722 Clarkson Rd
Chesterfield, MO 63017-4976
Chesterfield, MO 63017-4976
Phone 636-206-2665 · Fax 636-206-2664
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