MEDICARE: KENDRA LEARTRICE COBB

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	376K00000X	Nurse's Aide	1746	MO

General Provider Information

NPI Number	:	1427834852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA LEARTRICE COBB

Provider Business Mailing Address
First Line	:	725 BABLER DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-4002
Country	:	US
Telephone Number	:	314-435-6979
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 BABLER DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-4002
Country	:	US
Telephone Number	:	314-435-6979
Fax Number	:

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

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	09/01/2023

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Directions to “ KENDRA LEARTRICE COBB ” Practice Location

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