Provider Demographics
NPI:1356860654
Name:HARRISON, KUNESHA
Entity Type:Individual
Prefix:MRS
First Name:KUNESHA
Middle Name:
Last Name:HARRISON
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 1:1535 SAINT LORETTO DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3317
Mailing Address - Country:US
Mailing Address - Phone:314-484-4395
Mailing Address - Fax:
Practice Address - Street 1:2 CITYPLACE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7096
Practice Address - Country:US
Practice Address - Phone:314-812-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health