Healthcare Provider Details

I. General information

NPI: 1225700792
Provider Name (Legal Business Name): NEKEA ALYSE SMITH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3396 PERSHALL RD
SAINT LOUIS MO
63135-1407
US

IV. Provider business mailing address

3396 PERSHALL RD
SAINT LOUIS MO
63135-1407
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-8700
  • Fax: 314-814-8542
Mailing address:
  • Phone: 314-814-8700
  • Fax: 314-814-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2025024607
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number33431
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: