Provider Demographics
NPI:1861103988
Name:SMITH, KYLIE
Entity type:Individual
Prefix:MRS
First Name:KYLIE
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 1:1446 DEUCE CIR
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8500
Mailing Address - Country:US
Mailing Address - Phone:225-331-0808
Mailing Address - Fax:
Practice Address - Street 1:1446 DEUCE CIR
Practice Address - Street 2:
Practice Address - City:CHAMPIONS GT
Practice Address - State:FL
Practice Address - Zip Code:33896-8500
Practice Address - Country:US
Practice Address - Phone:225-331-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator