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NPI Code Detail

MEDICARE: MS. KELLY PAYNE SMITH R.D.

MEDICARE: MS. KELLY PAYNE SMITH R.D.
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
1133V00000XRegistered Dietitian1036238CO

General Provider Information

NPI Number : 1760743918
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY PAYNE SMITH R.D.
Provider Business Mailing Address
First Line : 819 DUNSTON ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-4130
Country : US
Telephone Number : 719-237-7181
Fax Number :
Provider Business Practice Location Address
First Line : 9320 GRAND CORDERA PKWY STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80924-7004
Country : US
Telephone Number : 719-344-2780
Fax Number : 855-803-5480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2012
Last Update Date : 03/17/2018

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