Provider Demographics
NPI:1811941248
Name:LEMOINE, KIMBERLY D (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:LEMOINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:CONNET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 695A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-872-7400
Practice Address - Fax:314-872-9126
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014392207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208442301Medicaid
MO922182295Medicare ID - Type Unspecified
MO208442301Medicaid