MEDICARE: KELSEE 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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1255192167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEE SMITH

Provider Business Mailing Address
First Line	:	2033 6TH AVE STE 988
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-2568
Country	:	US
Telephone Number	:	866-624-4824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 6TH AVE STE 988
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-2568
Country	:	US
Telephone Number	:	866-624-4824
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	02/09/2026

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Directions to “ KELSEE SMITH ” Practice Location

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