| Doctor Name: | KENEISHIA ELIJAH |
| NPI Number: | 1144649591 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LC1370973 |
| Business Practice Address: | 16720 Stone Creek Ct Florissant, MO - 630341019 |
| Business Phone Number: | 3147364275 |
| Business Fax Number: | 3142606781 |
| Mailing Address: | 16720 Stone Creek Ct, FLORISSANT |
| State: | MO |
| Postal Code: | 630341019 |
| Phone Number: | 3147364275 |
| Fax Number: | 3142606781 |
| NPI Enumeration Date: | 04/14/2014 |
| NPI Last Update Date: | 04/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | LC1370973 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |