MEDICARE: KAMMIELL SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20295	MT

General Provider Information

NPI Number	:	1437430246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMMIELL SMITH

Provider Business Mailing Address
First Line	:	100 GARNET WAY
Second Line	:	PO BOX 300
City	:	WARM SPRINGS
State	:	MT
Zip	:	59756-9705
Country	:	US
Telephone Number	:	406-693-7008
Fax Number	:	406-444-3082

Provider Business Practice Location Address
First Line	:	300 GARNET WAY
Second Line	:
City	:	WARM SPRINGS
State	:	MT
Zip	:	59756-0300
Country	:	US
Telephone Number	:	406-693-7008
Fax Number	:	406-444-3082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/07/2011

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Directions to “ KAMMIELL SMITH ” Practice Location

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