MEDICARE: MRS. KACEY DANYELL 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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1790527729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KACEY DANYELL SMITH

Provider Business Mailing Address
First Line	:	5570 FM 423 STE 250
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-8929
Country	:	US
Telephone Number	:	214-578-2391
Fax Number	:

Provider Business Practice Location Address
First Line	:	5570 FM 423 STE 250
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-8929
Country	:	US
Telephone Number	:	214-578-2391
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “ MRS. KACEY DANYELL SMITH ” Practice Location

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