MEDICARE: MRS. SHANTA KANICA MORRIS

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	171400000X	Health & Wellness Coach		MO

General Provider Information

NPI Number	:	1356205579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANTA KANICA MORRIS

Provider Business Mailing Address
First Line	:	845 N HIGHWAY 67 ST
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-2915
Country	:	US
Telephone Number	:	314-518-5530
Fax Number	:	314-300-8114

Provider Business Practice Location Address
First Line	:	845 N HIGHWAY 67 ST
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-2915
Country	:	US
Telephone Number	:	314-518-5530
Fax Number	:	314-300-8114

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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