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General NPI Number Information
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NPI Number | 1811295850
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Entity Type | Individual
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Provider Name | KENISHA LEANDRA BRYANT WHNP
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Gender | Female
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 4901 FOREST PARK AVE STE 341 STE 341
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1453
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Country | US
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Telephone | 314-454-7882
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Fax | 314-454-5167
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Provider Business Mailing Address
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Address Line | 4901 FOREST PARK AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1402
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Country | US
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Telephone | 314-454-7882
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Fax | 314-454-5467
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 2002018066
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License Number State | MO
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