MEDICARE: KAYLEIGH REY SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1013622422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEIGH REY SMITH

Provider Business Mailing Address
First Line	:	99 RIGGS PL
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5211
Country	:	US
Telephone Number	:	973-440-7611
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 RIGGS PL
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5211
Country	:	US
Telephone Number	:	973-440-7611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	01/19/2023

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Directions to “ KAYLEIGH REY SMITH ” Practice Location

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