Provider Demographics
NPI:1336784461
Name:BETTS, KYRA
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:BETTS
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 1:28 COLUMBUS SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-2746
Mailing Address - Country:US
Mailing Address - Phone:314-387-8181
Mailing Address - Fax:
Practice Address - Street 1:28 COLUMBUS SQUARE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-2746
Practice Address - Country:US
Practice Address - Phone:314-387-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula