Healthcare Provider Details

I. General information

NPI: 1912657875
Provider Name (Legal Business Name): KARLYE D SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 MARKET ST
SAN FRANCISCO CA
94104-5401
US

IV. Provider business mailing address

1505 W AVENUE L
LOVINGTON NM
88260-5353
US

V. Phone/Fax

Practice location:
  • Phone: 832-304-3347
  • Fax:
Mailing address:
  • Phone: 575-552-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: