Provider Demographics
NPI:1811613862
Name:KYLES, CONEISHA DEANDRA
Entity type:Individual
Prefix:
First Name:CONEISHA
Middle Name:DEANDRA
Last Name:KYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 LINDELL BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2053
Mailing Address - Country:US
Mailing Address - Phone:314-240-5552
Mailing Address - Fax:314-240-5562
Practice Address - Street 1:4144 LINDELL BLVD STE 135
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2053
Practice Address - Country:US
Practice Address - Phone:314-688-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide