Provider Demographics
NPI:1902421696
Name:BENGE-SHEA, KIERA MARGARET (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIERA
Middle Name:MARGARET
Last Name:BENGE-SHEA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:KIERA
Other - Middle Name:MARGARET
Other - Last Name:BENGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11425 TIVOLI LN APT F
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3596
Mailing Address - Country:US
Mailing Address - Phone:515-822-3921
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD UNIT 7005
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-991-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1828108213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist