Healthcare Provider Details

I. General information

NPI: 1588583207
Provider Name (Legal Business Name): KELLI LASHAUN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MUD RUN ROAD
CYCLONE WV
24827
US

IV. Provider business mailing address

PO BOX 202
CYCLONE WV
24827-0202
US

V. Phone/Fax

Practice location:
  • Phone: 304-732-1293
  • Fax:
Mailing address:
  • Phone: 304-732-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: