Provider Demographics
NPI:1639783426
Name:LEAHY-SMITH, KIMBERLY (CNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LEAHY-SMITH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 RHAPSODY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-9205
Mailing Address - Country:US
Mailing Address - Phone:866-416-3398
Mailing Address - Fax:856-556-3773
Practice Address - Street 1:122 RHAPSODY CT
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9205
Practice Address - Country:US
Practice Address - Phone:812-718-9090
Practice Address - Fax:812-718-9090
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAN3983232278H0200X, 2279H0200X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCNA398323OtherCNA LICENSE