Provider Demographics
NPI:1831742105
Name:SMITH, KELLIE (APRN)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:SMITH
Other - Last Name:WALIGORSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:415 KY 225
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7759
Mailing Address - Country:US
Mailing Address - Phone:606-619-4086
Mailing Address - Fax:
Practice Address - Street 1:415 KY 225
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7759
Practice Address - Country:US
Practice Address - Phone:606-619-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily