Basic Information
| Provider Information | |||||||||
| NPI: | 1962853986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUINN | ||||||||
| FirstName: | KIMBER | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BARRETT | ||||||||
| OtherFirstName: | KIMBER | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 400 N KEENE ST | ||||||||
| Address2: | SOUTH PAVILION | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652016626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738824438 | ||||||||
| FaxNumber: | 5838849992 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 BAGNELL DAM BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKE OZARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650498658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733652318 | ||||||||
| FaxNumber: | 5733653009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2016 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2019015005 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2019015005 | 01 | MO | STATE LICENSE | OTHER |