Provider Demographics
NPI:1962588210
Name:ESSNER, KIMBERLY (MS-PAC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:ESSNER
Suffix:
Gender:F
Credentials:MS-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N ONE MILE RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-1000
Mailing Address - Country:US
Mailing Address - Phone:573-624-5566
Mailing Address - Fax:573-624-8895
Practice Address - Street 1:115 E BUSINESS US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1219
Practice Address - Country:US
Practice Address - Phone:573-624-7575
Practice Address - Fax:573-624-3157
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005008045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ52286Medicare UPIN