Healthcare Provider Details

I. General information

NPI: 1649049842
Provider Name (Legal Business Name): BETTY JEAN KERR PEOPLE'S HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5669 DELMAR BLVD.
ST. LOUIS MO
63112
US

IV. Provider business mailing address

5701 DELMAR BLVD.
ST. LOUIS MO
63112-2617
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-1770
  • Fax: 314-241-1185
Mailing address:
  • Phone: 314-367-7848
  • Fax: 314-367-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK SANFORD
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 314-367-7848