Healthcare Provider Details

I. General information

NPI: 1174487607
Provider Name (Legal Business Name): KENE R BRATCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 ADELAIDE AVE
SAINT LOUIS MO
63115-3031
US

IV. Provider business mailing address

4528 ADELAIDE AVE
SAINT LOUIS MO
63115-3031
US

V. Phone/Fax

Practice location:
  • Phone: 314-601-4549
  • Fax:
Mailing address:
  • Phone: 314-601-4549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: