MEDICARE: KEVIN KIMBERLY SMITH MD

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	207P00000X	Emergency Medicine Physician	MD00023951	WA
2	208D00000X	General Practice Physician	MD00023951	WA

General Provider Information

NPI Number	:	1790847952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN KIMBERLY SMITH MD

Provider Business Mailing Address
First Line	:	1550 S PIONEER WAY STE 100
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-4637
Country	:	US
Telephone Number	:	509-765-6525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 S PIONEER WAY STE 100
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-4637
Country	:	US
Telephone Number	:	509-765-6525
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	09/11/2025

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Directions to “ KEVIN KIMBERLY SMITH MD” Practice Location

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