Kimberly Marie Wickline, AGNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2021043381 Issued in MO

Practice address

15945 Clayton Rd Ste 340
Ballwin, MO 63011-2492

Phone

(636) 256-5130

NPI assigned

Nov 19, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwickline1075036@directc.mercy.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mercy Clinic East Communities

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1851335228

  Single Specialty

  Medicare reassignment NPD
• Ortho Missouri, LLC

  • Orthopaedic Surgery Physician
  • Creve Coeur, MO
  • NPI 1447941067

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1376200733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15945 CLAYTON RD STE 340",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112492",
            "telephone_number": "636-256-5130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15945 CLAYTON RD STE 340",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112492",
            "telephone_number": "636-256-5130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLINE",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "AGNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-19",
        "last_updated": "2022-02-08",
        "certification_date": "2022-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2021043381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Western Nursing & Rehabilitation Center LLC
• Wendy Westmoreland, RBT
• Emily Wheeler, D.C.
• Krystal M Wheelis, LMSW
• Erika-Renee White
• Charles Wight, RBT
• Beverly Ann Wilhelm-Oney, MD
• Ashley Nicole Williams-Farmer, DO
• Grace Ann Williams
• Jennifer Williams, FNP-C

• Adult Health Nurse Practitioner in Ballwin, MO
• Providers in Ballwin, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.