Healthcare Provider Details

I. General information

NPI: 1558817072
Provider Name (Legal Business Name): KENDALL SPENCER SMITH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 PAMALEE DR
FAYETTEVILLE NC
28303-3974
US

IV. Provider business mailing address

PO BOX 40908
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-482-3000
  • Fax: 910-482-0397
Mailing address:
  • Phone: 910-615-6949
  • Fax: 910-615-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008758
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: