Individual provider · Type 1 NPI

Kimberly Marie Wickline, AGNP

Adult Health Nurse Practitioner · Ballwin, MO

NPI number 1376200733 Active

Practice location

15945 Clayton Rd Ste 340
Ballwin, MO 63011-2492

Call (636) 256-5130 Map

Other practice locations

  • 633 Emerson Rd Ste 10, Creve Coeur, MO 63141-6739 · (314) 991-2013

Specialties and licenses

TaxonomyCodeLicense
Adult Health Nurse Practitioner Primary 363LA2200X2021043381 (MO)

Adult Health Nurse Practitioner: Definition to come...

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About NPI 1376200733

Kimberly Marie Wickline, AGNP's National Provider Identifier is 1376200733, issued on Nov 19, 2021. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Ballwin, MO. The record was last updated on Oct 9, 2026.