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NPI Code Detail

MEDICARE: TINA MARIE GUYNN BCC

MEDICARE: TINA MARIE GUYNN BCC
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
1374K00000XReligious Nonmedical Practitioner64581

General Provider Information

NPI Number : 1285311746
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MARIE GUYNN BCC
Provider Business Mailing Address
First Line : 4600 EDMUNDSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-3806
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4600 EDMUNDSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-3806
Country : US
Telephone Number : 317-583-4707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2023
Last Update Date : 06/28/2023

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