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General NPI Number Information
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NPI Number | 1891004610
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Entity Type | Individual
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Provider Name | KAYODE KWESI SMITH KAYODE KWESI SMITH
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Gender | Male
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 339 HICKS ST
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City | BROOKLYN
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State | NY
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Zip | 11201-5509
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Country | US
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Telephone | 718-780-1206
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Fax |
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Provider Business Mailing Address
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Address Line | 203 REMSEN AVE
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City | BROOKLYN
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State | NY
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Zip | 11212-1342
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Country | US
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Telephone | 718-975-0654
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 336326
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License Number State | NY
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