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General NPI Number Information
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NPI Number | 1508737206
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Entity Type | Individual
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Provider Name | KIESHA THOMAS
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Gender | Female
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 2932 HICKORY ST
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1817
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Country | US
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Telephone | 314-828-0218
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Fax |
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Provider Business Mailing Address
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Address Line | 2932 HICKORY ST
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1817
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Country | US
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Telephone |
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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 | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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