Healthcare Provider Details

I. General information

NPI: 1801205273
Provider Name (Legal Business Name): A CONFIDENT YOU STYLES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2014
Last Update Date: 08/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 MEXICO RD
SAINT PETERS MO
63376-1389
US

IV. Provider business mailing address

7501 MEXICO RD
SAINT PETERS MO
63376-1389
US

V. Phone/Fax

Practice location:
  • Phone: 314-750-7262
  • Fax: 636-278-7722
Mailing address:
  • Phone: 314-750-7262
  • Fax: 636-278-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number2002026446
License Number StateMO

VIII. Authorized Official

Name: MRS. JEAN BALLARD CAMPBELL
Title or Position: OWNERCERTIFIED HAIR LOSS SPECIALIST
Credential:
Phone: 314-750-7262