Provider Demographics
NPI:1417401720
Name:SMITH, KELSEY HAMMOND (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:HAMMOND
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 RIDLEY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2762
Mailing Address - Country:US
Mailing Address - Phone:706-756-1066
Mailing Address - Fax:706-948-8648
Practice Address - Street 1:209 RIDLEY AVE STE C
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2762
Practice Address - Country:US
Practice Address - Phone:706-756-1066
Practice Address - Fax:706-948-8648
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner