Healthcare Provider Details

I. General information

NPI: 1881892552
Provider Name (Legal Business Name): KIMBERLY MCCULLOUGH SMASH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KIMBERLY ANITRA MCCULLOUGH

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 GLACIER HWY
JUNEAU AK
99801-9501
US

IV. Provider business mailing address

PO BOX 1020
JACKSON MS
39215-1020
US

V. Phone/Fax

Practice location:
  • Phone: 907-463-3303
  • Fax:
Mailing address:
  • Phone: 601-718-0308
  • Fax: 855-838-7032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301090322
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21233
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: