Healthcare Provider Details

I. General information

NPI: 1285541649
Provider Name (Legal Business Name): KELLY ANN SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

503 HILLCREST ST
LANSING KS
66043-2228
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax: 913-758-4277
Mailing address:
  • Phone: 913-682-2000
  • Fax: 913-758-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2014024910
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-99032-062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: