Healthcare Provider Details

I. General information

NPI: 1457199838
Provider Name (Legal Business Name): KEYSHAWN MARKEVION BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 CRAIG RD
SAINT LOUIS MO
63146-4760
US

IV. Provider business mailing address

1810 CRAIG RD STE 127
SAINT LOUIS MO
63146-4767
US

V. Phone/Fax

Practice location:
  • Phone: 833-490-8535
  • Fax:
Mailing address:
  • Phone: 833-490-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: