Healthcare Provider Details

I. General information

NPI: 1285153445
Provider Name (Legal Business Name): KEWANA M BROWN EXECUTIVE CODIRECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5824 MAPLE AVENUE
SAINT LOUIS MO
63112-6311
US

IV. Provider business mailing address

5824 MAPLE AVE
SAINT LOUIS MO
63112-2415
US

V. Phone/Fax

Practice location:
  • Phone: 314-282-0427
  • Fax:
Mailing address:
  • Phone: 314-282-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: