Individual
MRS. KENISHA LEANDRA BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
4901 FOREST PARK AVE STE 341, STE 341, SAINT LOUIS, MO 63108-1453
(314) 454-7882
(314) 454-5167
Mailing address
4901 FOREST PARK AVE, SAINT LOUIS, MO 63108-1402
(314) 454-7882
(314) 454-5467
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
2002018066
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IL
Enumeration date
02/28/2011
Last updated
01/24/2018
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