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General NPI Number Information
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NPI Number | 1285473769
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Entity Type | Individual
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Provider Name | BRETT KELSO SMEDLEY
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Gender | Male
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 44045 RIVERSIDE PKWY STE N112
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City | LEESBURG
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State | VA
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Zip | 20176-5101
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Country | US
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Telephone | 703-858-6020
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Fax | 703-858-6007
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Provider Business Mailing Address
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Address Line | 43596 MERCHANT MILL TER
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City | LEESBURG
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State | VA
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Zip | 20176-8228
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Country | US
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Telephone | 571-455-2676
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0203020897
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License Number State | VA
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