Healthcare Provider Details

I. General information

NPI: 1831689868
Provider Name (Legal Business Name): JENNIFER LEE KENT HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 OLD DES PERES RD
DES PERES MO
63131-1865
US

IV. Provider business mailing address

1010 OLD DES PERES RD
DES PERES MO
63131-1865
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-0077
  • Fax: 314-729-0101
Mailing address:
  • Phone: 314-729-0077
  • Fax: 314-729-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2018015576
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2018015576
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: