Healthcare Provider Details

I. General information

NPI: 1215891379
Provider Name (Legal Business Name): LAKEISHA S GREENARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 CALLE VISTA DR
FLORISSANT MO
63031-7619
US

IV. Provider business mailing address

2425 CALLE VISTA DR
FLORISSANT MO
63031-7619
US

V. Phone/Fax

Practice location:
  • Phone: 314-873-2431
  • Fax:
Mailing address:
  • Phone: 314-873-2431
  • Fax: 314-873-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: