Provider Demographics
NPI:1144695065
Name:SMITH, KEELEIGH
Entity type:Individual
Prefix:
First Name:KEELEIGH
Middle Name:
Last Name:SMITH
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 1:1430 LOUISIANA ST
Mailing Address - Street 2:APT 10
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3428
Mailing Address - Country:US
Mailing Address - Phone:316-648-5749
Mailing Address - Fax:
Practice Address - Street 1:1430 LOUISIANA ST
Practice Address - Street 2:APT 10
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3428
Practice Address - Country:US
Practice Address - Phone:316-648-5749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator