Provider Demographics
NPI:1457978132
Name:SMITH, KEAMAK DENISE
Entity Type:Individual
Prefix:MISS
First Name:KEAMAK
Middle Name:DENISE
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 1:1546 QUAIL TRACE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5252
Mailing Address - Country:US
Mailing Address - Phone:281-773-1079
Mailing Address - Fax:866-855-6282
Practice Address - Street 1:2425 WEST LOOP S STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4208
Practice Address - Country:US
Practice Address - Phone:866-424-9202
Practice Address - Fax:866-855-6282
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver