Healthcare Provider Details

I. General information

NPI: 1811187826
Provider Name (Legal Business Name): KIM S SMITH L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9580 REFUGEE RD SW
PATASKALA OH
43062-8628
US

IV. Provider business mailing address

9580 REFUGEE RD SW
PATASKALA OH
43062-8628
US

V. Phone/Fax

Practice location:
  • Phone: 740-964-6246
  • Fax:
Mailing address:
  • Phone: 740-964-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.074535
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: