Provider Demographics
NPI:1548460934
Name:SMITH, DORIS REAN
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:REAN
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 1:3500 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128-2559
Mailing Address - Country:US
Mailing Address - Phone:816-517-7288
Mailing Address - Fax:
Practice Address - Street 1:211 E EXCELSIOR ST APT 2
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-2264
Practice Address - Country:US
Practice Address - Phone:816-517-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO373H00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No376K00000XNursing Service Related ProvidersNurse's Aide