Doctor Name: | MRS. KELLY NICOLE SMITH |
NPI Number: | 1366870974 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | 14762 |
Business Practice Address: | 7581 Secor Rd Lambertville, MI - 481449624 |
Business Phone Number: | 7348566306 |
Business Fax Number: | |
Mailing Address: | 7581 Secor Rd, LAMBERTVILLE |
State: | MI |
Postal Code: | 481449624 |
Phone Number: | 7348566306 |
Fax Number: | |
NPI Enumeration Date: | 10/16/2013 |
NPI Last Update Date: | 10/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 14762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |