MEDICARE: TIELIA KERN

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	376K00000X	Nurse's Aide	2017084	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2017084	OTHER	MO	CNA LICENSE

General Provider Information

NPI Number	:	1922768449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIELIA KERN

Provider Business Mailing Address
First Line	:	3056 FAIR AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-3230
Country	:	US
Telephone Number	:	402-598-2048
Fax Number	:

Provider Business Practice Location Address
First Line	:	3056 FAIR AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-3230
Country	:	US
Telephone Number	:	402-598-2048
Fax Number	:

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

Provider Enumeration Date	:	12/23/2021
Last Update Date	:	12/23/2021

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Directions to “ TIELIA KERN ” Practice Location

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