Healthcare Provider Details

I. General information

NPI: 1508859851
Provider Name (Legal Business Name): KANETTE TURNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 MARTIN LUTHER KING BLVD
SAINT LOUIS MO
63140-1623
US

IV. Provider business mailing address

5471 MARTIN LUTHER KING BLVD
SAINT LOUIS MO
63140-1623
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-5820
  • Fax: 314-367-7010
Mailing address:
  • Phone: 314-367-5820
  • Fax: 314-367-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number143424
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: