MEDICARE: KENNYSHIA TAMIKO WEBB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1285359224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNYSHIA TAMIKO WEBB

Provider Business Mailing Address
First Line	:	4200 UNION BLVD # 160
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 N 14TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-3731
Country	:	US
Telephone Number	:	618-727-6363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	12/28/2022

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Directions to “ KENNYSHIA TAMIKO WEBB ” Practice Location

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