Healthcare Provider Details

I. General information

NPI: 1427644178
Provider Name (Legal Business Name): KATELYN HATCHER SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MYRTLE ST
BELMONT NC
28012-5200
US

IV. Provider business mailing address

4575 SE DIXIE HWY
STUART FL
34997-6826
US

V. Phone/Fax

Practice location:
  • Phone: 704-954-8959
  • Fax: 980-207-2773
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number331
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: