Provider Demographics
NPI:1811257611
Name:LEE, KIMBERLY THOMPSON (FNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:THOMPSON
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-454-6165
Mailing Address - Fax:314-454-2381
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV SURG CT PEDS, STE 2A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6165
Practice Address - Fax:314-454-2381
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025988363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429844301Medicaid
ILENROLLEDMedicaid