Individual
KELLY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2232 WILBORN AVE STE D, SOUTH BOSTON, VA 24592-1662
(434) 575-1212
Mailing address
2232 WILBORN AVE STE D, SOUTH BOSTON, VA 24592-1662
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024172518
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024172518
VA LICENSE
VA
Enumeration date
04/08/2015
Last updated
04/08/2015
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