Healthcare Provider Details

I. General information

NPI: 1437367836
Provider Name (Legal Business Name): MRS. SHARON SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 BROWN RD
SAINT LOUIS MO
63114-4906
US

IV. Provider business mailing address

1024 PEARVIEW DR
SAINT PETERS MO
63376-2269
US

V. Phone/Fax

Practice location:
  • Phone: 314-427-2650
  • Fax: 314-426-1474
Mailing address:
  • Phone: 636-240-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: