Provider Demographics
NPI:1821664400
Name:SMITH, KAYLEY DARLENE
Entity Type:Individual
Prefix:
First Name:KAYLEY
Middle Name:DARLENE
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 1:2027 THE WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1297
Mailing Address - Country:US
Mailing Address - Phone:618-616-2280
Mailing Address - Fax:
Practice Address - Street 1:2027 THE WOODS CIR
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1297
Practice Address - Country:US
Practice Address - Phone:618-616-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019022121163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019022121OtherNURSING LICENSE NUMBER