Healthcare Provider Details

I. General information

NPI: 1538072905
Provider Name (Legal Business Name): KELLY LEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SW LEE ST
NEWPORT OR
97365-3823
US

IV. Provider business mailing address

363 NE DOUGLAS ST
TOLEDO OR
97391-1429
US

V. Phone/Fax

Practice location:
  • Phone: 541-270-4817
  • Fax:
Mailing address:
  • Phone: 541-961-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: