Healthcare Provider Details

I. General information

NPI: 1649702929
Provider Name (Legal Business Name): TAMIKA L RENFROE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 N KINGSHIGHWAY BLVD SUITE 112
SAINT LOUIS MO
63115-1736
US

IV. Provider business mailing address

3737 N KINGSHIGHWAY BLVD SUITE 112
SAINT LOUIS MO
63115-1736
US

V. Phone/Fax

Practice location:
  • Phone: 314-339-5872
  • Fax: 314-552-7591
Mailing address:
  • Phone: 314-339-5872
  • Fax: 314-552-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: