Provider Demographics
NPI:1912128067
Name:SMETTE, KECIA RAE (DO)
Entity Type:Individual
Prefix:
First Name:KECIA
Middle Name:RAE
Last Name:SMETTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60123
Mailing Address - Street 2:NO APPOINTMENT MD
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-0123
Mailing Address - Country:US
Mailing Address - Phone:602-992-7700
Mailing Address - Fax:602-971-2572
Practice Address - Street 1:6677 W THUNDERBIRD RD STE A124
Practice Address - Street 2:NO APPOINTMENT MD
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3710
Practice Address - Country:US
Practice Address - Phone:623-773-2266
Practice Address - Fax:623-773-2267
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ443243Medicaid
AZ443243Medicaid