Provider Demographics
NPI:1851676571
Name:SMITH, KELLY A (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 EAST ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1364
Mailing Address - Country:US
Mailing Address - Phone:585-396-3821
Mailing Address - Fax:585-396-3957
Practice Address - Street 1:435 EAST ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1364
Practice Address - Country:US
Practice Address - Phone:585-396-3821
Practice Address - Fax:585-396-3957
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376695-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool