MEDICARE: MACAYLA KENT

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	163W00000X	Registered Nurse	000000000	MO

General Provider Information

NPI Number	:	1891517025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACAYLA KENT

Provider Business Mailing Address
First Line	:	3220 NEBRASKA AVE APT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 NEBRASKA AVE APT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2909
Country	:	US
Telephone Number	:	314-845-4150
Fax Number	:

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

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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Directions to “ MACAYLA KENT ” Practice Location

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