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General NPI Number Information
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NPI Number | 1033855341
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Entity Type | Organization
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Legal Business Name | KALENA SMITH
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 12219 HIGHWAY 503
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City | DECATUR
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State | MS
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Zip | 39327-8915
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Country | US
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Telephone | 470-510-6452
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Fax |
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Provider Business Mailing Address
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Address Line | 12219 HIGHWAY 503
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City | DECATUR
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State | MS
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Zip | 39327-8915
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Country | US
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Telephone | 470-510-6452
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MS. KALENA Y SMITH
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Credential | LPN
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Telephone | 470-510-6452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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