Healthcare Provider Details

I. General information

NPI: 1780351452
Provider Name (Legal Business Name): KAYLI SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 RIDGEWAY LOOP RD
MEMPHIS TN
38120-4038
US

IV. Provider business mailing address

6250 HIGHWAY 64 STE 5
OAKLAND TN
38060-5175
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-1282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number7881
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: