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General NPI Number Information
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NPI Number | 1508339391
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Entity Type | Individual
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Provider Name | KYLE BRADLEY SMITH
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Gender | Male
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 600 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53792-1932
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Country | US
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Telephone | 608-263-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 OLD LEEDS LN
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City | MOUNTAIN BRK
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State | AL
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Zip | 35213-3228
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Country | US
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Telephone |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1-140013
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 140013
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License Number State | WI
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