Healthcare Provider Details

I. General information

NPI: 1346877362
Provider Name (Legal Business Name): KYNDALL SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD STE 200
CHARLOTTE NC
28203-5865
US

IV. Provider business mailing address

2607 CAROLINE AVE
COLUMBUS OH
43209-1071
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-8170
  • Fax:
Mailing address:
  • Phone: 423-863-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2026-00643
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number96159
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: