Provider Demographics
NPI:1770846685
Name:SMITH, NICHOLE RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7450 KESSLER ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2519
Mailing Address - Country:US
Mailing Address - Phone:913-676-7585
Mailing Address - Fax:913-676-8189
Practice Address - Street 1:7450 KESSLER ST STE 203
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2519
Practice Address - Country:US
Practice Address - Phone:913-676-7585
Practice Address - Fax:913-676-8189
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0439913207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism