Provider Demographics
NPI:1114772407
Name:SMITH, KYJAHKRISTINE DEONA LAKARAH
Entity Type:Individual
Prefix:
First Name:KYJAHKRISTINE
Middle Name:DEONA LAKARAH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 AUTUMN HILLS DR APT 1
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1321
Mailing Address - Country:US
Mailing Address - Phone:937-250-4799
Mailing Address - Fax:
Practice Address - Street 1:5512 AUTUMN HILLS DR APT 1
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-1321
Practice Address - Country:US
Practice Address - Phone:937-250-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide