Provider Demographics
NPI: | 1851820997 |
---|---|
Name: | KEMPER, JAMIKA (RN) |
Entity type: | Individual |
Prefix: | |
First Name: | JAMIKA |
Middle Name: | |
Last Name: | KEMPER |
Suffix: | |
Gender: | F |
Credentials: | RN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 5960 HOWDERSHELL RD STE 104 |
Mailing Address - Street 2: | |
Mailing Address - City: | HAZELWOOD |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 63042-4102 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 314-477-2469 |
Mailing Address - Fax: | 636-800-2495 |
Practice Address - Street 1: | 5960 HOWDERSHELL RD STE 104 |
Practice Address - Street 2: | |
Practice Address - City: | HAZELWOOD |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63042-4102 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-477-2469 |
Practice Address - Fax: | 636-800-2495 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2017-06-11 |
Last Update Date: | 2024-10-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 041419846 | 163W00000X |
MO | 2011003666 | 163WL0100X, 163W00000X |
253Z00000X | ||
MO | 374J00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 163WL0100X | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No | 253Z00000X | Agencies | In Home Supportive Care | |
No | 374J00000X | Nursing Service Related Providers | Doula |