Provider Demographics
NPI:1720846645
Name:MCLEMORE, SHONTA LATRICE (DOULA)
Entity Type:Individual
Prefix:MS
First Name:SHONTA
Middle Name:LATRICE
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 OAKMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4841
Mailing Address - Country:US
Mailing Address - Phone:314-546-7267
Mailing Address - Fax:
Practice Address - Street 1:3727 OAKMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4841
Practice Address - Country:US
Practice Address - Phone:314-546-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty