Healthcare Provider Details

I. General information

NPI: 1952952236
Provider Name (Legal Business Name): ALEXIA KAYE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIA KAYE NEWELL

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 AMHERST DR
MARION OH
43302-6901
US

IV. Provider business mailing address

997 AMHERST DR
MARION OH
43302-6901
US

V. Phone/Fax

Practice location:
  • Phone: 740-361-1007
  • Fax:
Mailing address:
  • Phone: 740-361-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401518620513
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: