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General NPI Number Information
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NPI Number | 1689333866
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Entity Type | Individual
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Provider Name | KAYLA SMITH
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Gender | Female
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 512 W MAIN ST
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City | MAYO
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State | FL
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Zip | 32066-4136
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Country | US
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Telephone | 850-843-2339
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Fax |
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Provider Business Mailing Address
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Address Line | 2839 BERNARD JOHNSON RD
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City | PERRY
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State | FL
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Zip | 32347-8827
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Country | US
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Telephone | 850-843-2339
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW16722
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License Number State | FL
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