Provider Demographics
NPI:1811489255
Name:SMITH, KIKORA LAINI KAI
Entity type:Individual
Prefix:
First Name:KIKORA
Middle Name:LAINI KAI
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 SOLAMERE DR APT 106
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5881
Mailing Address - Country:US
Mailing Address - Phone:321-607-1281
Mailing Address - Fax:
Practice Address - Street 1:3880 CATALINA ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2211
Practice Address - Country:US
Practice Address - Phone:786-499-4694
Practice Address - Fax:321-208-7441
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112945200Medicaid