Doctor Name: | MS. KIMBERLY WALLACE |
NPI Number: | 1114249117 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LRN |
License Number: | 2007032845 |
Business Practice Address: | 925 Highway V V Kennett, MO - 63857 |
Business Phone Number: | 5738885925 |
Business Fax Number: | 5738889365 |
Mailing Address: | 500 Us Highway 61 North, HAYTI |
State: | MO |
Postal Code: | 63851 |
Phone Number: | 5733592600 |
Fax Number: | 5733591103 |
NPI Enumeration Date: | 02/18/2010 |
NPI Last Update Date: | 02/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163W00000X |
License Number: | 2007032845 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N. |