| Doctor Name: | MS. KIM DAMARIS YORK |
| NPI Number: | 1205207768 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | 2015030542 |
| Business Practice Address: | 70 Cedar Bluff Dr Apt 19 Lake St Louis, MO - 633672809 |
| Business Phone Number: | 6368872125 |
| Business Fax Number: | |
| Mailing Address: | 70 Cedar Bluff Dr Apt 19, LAKE ST LOUIS |
| State: | MO |
| Postal Code: | 633672809 |
| Phone Number: | 6368872125 |
| Fax Number: | |
| NPI Enumeration Date: | 10/09/2015 |
| NPI Last Update Date: | 10/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 2015030542 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |