Provider Demographics
NPI:1285153445
Name:BROWN, KEWANA M (EXECUTIVE CODIRECTOR)
Entity type:Individual
Prefix:
First Name:KEWANA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:EXECUTIVE CODIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2415
Mailing Address - Country:US
Mailing Address - Phone:314-282-0427
Mailing Address - Fax:
Practice Address - Street 1:5824 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-6311
Practice Address - Country:US
Practice Address - Phone:314-282-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion