Provider Demographics
NPI:1265300594
Name:SMITH, KIMBERLY Y
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:Y
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:Y
Other - Last Name:WASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 50031
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-5031
Mailing Address - Country:US
Mailing Address - Phone:314-956-3626
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 50031
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-5031
Practice Address - Country:US
Practice Address - Phone:314-956-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-28
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula