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General NPI Number Information
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NPI Number | 1992523658
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Entity Type | Individual
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Provider Name | CORIE KATHLEEN SMITH
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 200 S CEDAR ST
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City | SHELBYVILLE
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State | IL
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Zip | 62565-1838
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Country | US
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Telephone | 217-774-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S CEDAR ST
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City | SHELBYVILLE
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State | IL
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Zip | 62565-1838
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041480130
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209030862
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License Number State | IL
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