Provider Demographics
NPI:1669898516
Name:SMITH, KATHY (RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
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 1:305 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3323
Mailing Address - Country:US
Mailing Address - Phone:843-398-4400
Mailing Address - Fax:843-398-4418
Practice Address - Street 1:305 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3323
Practice Address - Country:US
Practice Address - Phone:843-398-4400
Practice Address - Fax:843-398-4418
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC53212163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse