Provider Demographics
NPI:1497753297
Name:SMITH, KAY A (CNM)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 BAY PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4921
Mailing Address - Country:US
Mailing Address - Phone:419-690-7596
Mailing Address - Fax:419-697-6707
Practice Address - Street 1:2751 BAY PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4921
Practice Address - Country:US
Practice Address - Phone:419-690-7596
Practice Address - Fax:419-697-6707
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04991176B00000X
OHNP02845363LW0102X
OHNM04991367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05225OtherPARAMOUNT
OH344428256OtherBEECHSTREET
OH344428256074OtherCARESOURCE
OH2016740Medicaid
OH344428256OtherFRONTPATH
OH000000064890OtherANTHEM
MI4091925Medicaid
OHNM03123Medicare PIN
MI4091925Medicaid
OH420000706Medicare PIN
OHNM76101Medicare PIN
OH000000064890OtherANTHEM
OH344428256OtherBEECHSTREET
OHSMNM03122Medicare PIN