Healthcare Provider Details

I. General information

NPI: 1093651572
Provider Name (Legal Business Name): KELSEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BANNING ST
DOVER DE
19904-3457
US

IV. Provider business mailing address

19 CAPANO DR APT A4
NEWARK DE
19702-1854
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010934
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: