Healthcare Provider Details

I. General information

NPI: 1306636402
Provider Name (Legal Business Name): KELSEY JUNE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 CREST RD
EAST FLAT ROCK NC
28726-2250
US

IV. Provider business mailing address

423 CREST RD
EAST FLAT ROCK NC
28726-2250
US

V. Phone/Fax

Practice location:
  • Phone: 828-808-8295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number272681
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: