Healthcare Provider Details

I. General information

NPI: 1174130215
Provider Name (Legal Business Name): KYLE A SMITH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6397 EMERALD PKWY
DUBLIN OH
43016-2200
US

IV. Provider business mailing address

PO BOX 734439
CHICAGO IL
60673-4439
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-6450
  • Fax: 614-383-6455
Mailing address:
  • Phone: 614-383-6450
  • Fax: 614-383-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0027506
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberAPRN.CNP.0027506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: