Healthcare Provider Details

I. General information

NPI: 1750226148
Provider Name (Legal Business Name): MRS. LATOSHA TRENA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROWN RD
SAINT LOUIS MO
63114-4327
US

IV. Provider business mailing address

3333 BROWN RD
SAINT LOUIS MO
63114-4327
US

V. Phone/Fax

Practice location:
  • Phone: 314-426-2211
  • Fax:
Mailing address:
  • Phone: 314-426-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2014009476
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: