Provider Demographics
NPI:1457348286
Name:MAILEY, KIRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:S
Last Name:MAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRA
Other - Middle Name:
Other - Last Name:STERNMAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-0007
Mailing Address - Country:US
Mailing Address - Phone:636-928-0078
Mailing Address - Fax:636-928-0089
Practice Address - Street 1:18 CHAPEL HILL EST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1315
Practice Address - Country:US
Practice Address - Phone:636-939-3166
Practice Address - Fax:636-939-3356
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8C99207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202740510Medicaid
MO202740510Medicaid
MO000003117Medicare ID - Type Unspecified