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General NPI Number Information
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NPI Number | 1104548981
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Entity Type | Individual
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Provider Name | KACEY SMITH
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 300 S MAIN ST UNIT 2
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City | WILDWOOD
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State | FL
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Zip | 34785-4542
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Country | US
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Telephone | 386-299-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 21253 S BUCKHILL RD
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City | CLERMONT
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State | FL
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Zip | 34715-9066
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Country | US
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Telephone | 386-299-8080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11021601
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License Number State | FL
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