Provider Demographics
NPI:1538698733
Name:GARAVAGLIA, KIMBERLY ANNE (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:GARAVAGLIA
Suffix:
Gender:F
Credentials:CPNP-PC
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Mailing Address - Street 1:5501 DELMAR BLVD STE B560
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3084
Mailing Address - Country:US
Mailing Address - Phone:314-833-4030
Mailing Address - Fax:314-833-4031
Practice Address - Street 1:9417 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-2009
Practice Address - Country:US
Practice Address - Phone:314-833-4030
Practice Address - Fax:314-833-4031
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2017006434208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics