Provider Demographics
NPI:1699536664
Name:SMITH, BREYONNA ANJANE (MA, CPHT)
Entity type:Individual
Prefix:MRS
First Name:BREYONNA
Middle Name:ANJANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 S BEMISTON AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1925
Mailing Address - Country:US
Mailing Address - Phone:314-718-9291
Mailing Address - Fax:
Practice Address - Street 1:231 S BEMISTON AVE STE 800
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1925
Practice Address - Country:US
Practice Address - Phone:314-718-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide