MEDICARE: KHADIAN 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	363LF0000X	Family Nurse Practitioner	SP020202	PA

General Provider Information

NPI Number	:	1629531108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHADIAN SMITH

Provider Business Mailing Address
First Line	:	325 SENTRY PKWY E STE 301
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-2312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 SENTRY PKWY E STE 301
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-2312
Country	:	US
Telephone Number	:	267-223-4241
Fax Number	:

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	01/21/2026

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Directions to “ KHADIAN SMITH ” Practice Location

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