Provider Demographics
NPI:1851527469
Name:HESS, KIMBERLY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:HESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 1001
Mailing Address - Street 2:TOWER B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8264
Mailing Address - Country:US
Mailing Address - Phone:314-791-9028
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 1001
Practice Address - Street 2:TOWER B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8264
Practice Address - Country:US
Practice Address - Phone:314-791-9028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009003431363AM0700X, 207P00000X
TXPA07394363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX865N33OtherBCBS-TX
TX292254401Medicaid
1851527469OtherTRICARE SOUTH
TX865N33OtherBCBS-TX
TXTXB146671Medicare PIN
MO132090007Medicare PIN