MEDICARE: SMART HEALTH AND WELLNESS, PLLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1558029504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART HEALTH AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	603 N LOGAN AVE
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-4320
Country	:	US
Telephone Number	:	217-280-8502
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 N LOGAN AVE
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-4320
Country	:	US
Telephone Number	:	217-280-8502
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAITLYN SMART
Credential	:	APRN-FPA
Telephone Number	:	217-280-8502

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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