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General NPI Number Information
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NPI Number | 1003759762
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Entity Type | Individual
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Provider Name | KENESHA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 4020 SAINT FERDINAND AVE APT B
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City | SAINT LOUIS
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State | MO
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Zip | 63113-3242
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Country | US
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Telephone | 314-585-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 SAINT FERDINAND AVE APT B
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City | SAINT LOUIS
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State | MO
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Zip | 63113-3242
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Country | US
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Telephone | 314-585-8770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 31554954
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License Number State | MO
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