Individual
KENYATTA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4502 FAIR AVE, SAINT LOUIS, MO 63115-3053
(314) 793-0251
Mailing address
4502 FAIR AVE, SAINT LOUIS, MO 63115-3053
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/16/2024
Last updated
01/16/2024
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