Provider Demographics
NPI:1982378139
Name:SMITH, KIMBERLY LYNNE (RN BSN IBCLC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 E WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-2089
Mailing Address - Country:US
Mailing Address - Phone:480-586-8541
Mailing Address - Fax:
Practice Address - Street 1:2107 E WILLIS RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2089
Practice Address - Country:US
Practice Address - Phone:480-586-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227329163WM0102X
AZ374J00000X
AZL-303739163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No374J00000XNursing Service Related ProvidersDoula