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NPI Code Detail

MEDICARE: MR. KENNETH E SMITH CNP

MEDICARE:  MR. KENNETH E SMITH  CNP
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
1363LA2200XAdult Health Nurse PractitionerAPRN.CNP.05173OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942203765
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH E SMITH CNP
Provider Business Mailing Address
First Line : PO BOX 746071
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6071
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3551 BELMONT AVE STE 19B
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44505-1439
Country : US
Telephone Number : 330-222-4030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 10/07/2022

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