Healthcare Provider Details

I. General information

NPI: 1700795630
Provider Name (Legal Business Name): GENENE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 W KENNEWICK AVE STE 150
KENNEWICK WA
99336-2968
US

IV. Provider business mailing address

8959 W QUINAULT AVE
KENNEWICK WA
99336-8136
US

V. Phone/Fax

Practice location:
  • Phone: 509-396-3688
  • Fax:
Mailing address:
  • Phone: 509-205-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: