MEDICARE: LAVARRA M GUYTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1043764376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVARRA M GUYTON

Provider Business Mailing Address
First Line	:	1712 S TUCKER BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-3427
Country	:	US
Telephone Number	:	314-441-8070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 S TUCKER BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-3427
Country	:	US
Telephone Number	:	314-441-8070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	11/13/2022

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Directions to “ LAVARRA M GUYTON ” Practice Location

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