Healthcare Provider Details

I. General information

NPI: 1669290045
Provider Name (Legal Business Name): LAKISHA JOY HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 TREMONT DR
FLORISSANT MO
63033-3057
US

IV. Provider business mailing address

3550 TREMONT DR
FLORISSANT MO
63033-3057
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-0278
  • Fax:
Mailing address:
  • Phone: 314-814-0278
  • Fax:

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: