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General NPI Number Information
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NPI Number | 1407313729
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Entity Type | Individual
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Provider Name | KELLY HANN SMITH CPNP
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Gender | Female
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 4109 WAKE FOREST RD STE 300
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City | RALEIGH
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State | NC
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Zip | 27609-2508
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Country | US
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Telephone | 919-250-3478
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Fax | 919-250-6272
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Provider Business Mailing Address
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Address Line | 4109 WAKE FOREST RD STE 300
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City | RALEIGH
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State | NC
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Zip | 27609-2508
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Country | US
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Telephone | 919-250-3478
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 5018023
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024177340
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 5018023
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License Number State | NC
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