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NPI Code Detail

MEDICARE: KODI ANN SMITH QBA

MEDICARE: KODI ANN SMITH QBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1588421440
Entity Type Code : Individual
Provider Name (Legal Business Name) : KODI ANN SMITH QBA
Provider Business Mailing Address
First Line : 10614 SHINY SKIES DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-4603
Country : US
Telephone Number : 907-982-9019
Fax Number :
Provider Business Practice Location Address
First Line : 7375 PRAIRIE FALCON RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0809
Country : US
Telephone Number : 725-205-2227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2024
Last Update Date : 03/06/2024

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Directions to “ KODI ANN SMITH QBA” Practice Location

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