Provider Demographics
NPI:1164110730
Name:SMITH, KAYLEE ELLEN (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ELLEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:ELLEN
Other - Last Name:SILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8601 DUNWOODY PL STE 565
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2516
Mailing Address - Country:US
Mailing Address - Phone:678-956-0005
Mailing Address - Fax:
Practice Address - Street 1:8601 DUNWOODY PL STE 565
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2516
Practice Address - Country:US
Practice Address - Phone:678-956-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4024803363LP0200X
GANP002718363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics