Healthcare Provider Details

I. General information

NPI: 1679497861
Provider Name (Legal Business Name): KELSEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

333 BOGLE ST
SOMERSET KY
42503-2873
US

IV. Provider business mailing address

82 KARENS RD
RUSSELL SPRINGS KY
42642-8819
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-0705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1173961
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: