Individual
KELLY PAYNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10554 N PORT WASHINGTON RD, MEQUON, WI 53092-5537
(414) 352-2766
(262) 241-5816
Mailing address
10554 N PORT WASHINGTON RD, MEQUON, WI 53092-5537
(414) 352-2766
(262) 241-5816
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
7838-33
WI
363L00000X
Nurse Practitioner
Primary
7838-33
WI
Other
Enumeration date
09/26/2017
Last updated
05/10/2019
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