Healthcare Provider Details

I. General information

NPI: 1891003927
Provider Name (Legal Business Name): MS. MARRIAH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 E 109TH TERR
KANSAS CITY MO
64138
US

IV. Provider business mailing address

4705 E 109TH TERR
KANSAS CITY MO
64138
US

V. Phone/Fax

Practice location:
  • Phone: 816-985-8852
  • Fax:
Mailing address:
  • Phone: 816-985-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number372600000X
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: