Healthcare Provider Details

I. General information

NPI: 1285056911
Provider Name (Legal Business Name): KENYA DENETTE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KENYA DENETTE SMITH N.P.

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 VAN NUYS BLVD STE 305
SHERMAN OAKS CA
91403-1717
US

IV. Provider business mailing address

5000 VAN NUYS BLVD STE 305
SHERMAN OAKS CA
91403-1717
US

V. Phone/Fax

Practice location:
  • Phone: 818-480-6456
  • Fax: 818-205-1924
Mailing address:
  • Phone: 818-480-6456
  • Fax: 818-205-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95000220
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number578715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: