Provider Demographics
NPI:1437430246
Name:SMITH, KAMMIELL
Entity Type:Individual
Prefix:
First Name:KAMMIELL
Middle Name:
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 1:100 GARNET WAY
Mailing Address - Street 2:PO BOX 300
Mailing Address - City:WARM SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59756-9705
Mailing Address - Country:US
Mailing Address - Phone:406-693-7008
Mailing Address - Fax:406-444-3082
Practice Address - Street 1:300 GARNET WAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756-0300
Practice Address - Country:US
Practice Address - Phone:406-693-7008
Practice Address - Fax:406-444-3082
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20295363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health