Provider Demographics
NPI:1144202102
Name:MCCALLUM, KIMBERLI ETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLI
Middle Name:ETTA
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:231 W LOCKWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2951
Mailing Address - Country:US
Mailing Address - Phone:314-968-1900
Mailing Address - Fax:314-968-1901
Practice Address - Street 1:231 W LOCKWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2951
Practice Address - Country:US
Practice Address - Phone:314-968-1900
Practice Address - Fax:314-968-1901
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR2K802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry