Healthcare Provider Details

I. General information

NPI: 1073589073
Provider Name (Legal Business Name): DELAINE RAY SMITH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW OAKLEY AVE
TOPEKA KS
66606-1995
US

IV. Provider business mailing address

330 SW OAKLEY AVE
TOPEKA KS
66606-1995
US

V. Phone/Fax

Practice location:
  • Phone: 785-233-1730
  • Fax: 785-273-2736
Mailing address:
  • Phone: 785-233-1730
  • Fax: 785-273-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number45214
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: