Individual
MRS. KELLY SMIDEBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
129 E REDSTONE AVE, SUITE A, CRESTVIEW, FL 32539-5350
(850) 682-7212
(850) 682-6302
Mailing address
129 E REDSTONE AVE, SUITE A, CRESTVIEW, FL 32539-5350
(850) 682-7212
(850) 682-6302
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9279024
FL
Other
Enumeration date
09/10/2012
Last updated
10/05/2012
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