Healthcare Provider Details

I. General information

NPI: 1740162890
Provider Name (Legal Business Name): MYA KEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4674 LEE AVE
SAINT LOUIS MO
63115-2400
US

IV. Provider business mailing address

4674 LEE AVE
SAINT LOUIS MO
63115-2400
US

V. Phone/Fax

Practice location:
  • Phone: 314-437-5888
  • Fax:
Mailing address:
  • Phone: 314-437-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number150008
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: