Healthcare Provider Details

I. General information

NPI: 1871411355
Provider Name (Legal Business Name): SHEKIEAH KEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1226 OLIVE ST UNIT 1006
SAINT LOUIS MO
63103-2476
US

IV. Provider business mailing address

1226 OLIVE ST UNIT 1006
SAINT LOUIS MO
63103-2476
US

V. Phone/Fax

Practice location:
  • Phone: 314-397-2517
  • Fax:
Mailing address:
  • Phone: 314-397-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041553620
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: