Healthcare Provider Details

I. General information

NPI: 1538670955
Provider Name (Legal Business Name): EMILY RENEE SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

536 E 1750 RD
BALDWIN CITY KS
66006-7361
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3400
  • Fax:
Mailing address:
  • Phone: 417-592-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number53-79755-111
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: