Healthcare Provider Details

I. General information

NPI: 1770983348
Provider Name (Legal Business Name): KIM ALMON SMITH MA, CADAC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W LINCOLN RD
KOKOMO IN
46902-3850
US

IV. Provider business mailing address

315 W LINCOLN RD
KOKOMO IN
46902-3850
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-4843
  • Fax:
Mailing address:
  • Phone: 765-450-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: