Individual
KELLY AMANDA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, CPNP-PC/AC
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-1000
Mailing address
2040 MARKET ST APT 1104, PHILADELPHIA, PA 19103-3369
(585) 739-0235
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
SP017721
PA
Other
Enumeration date
08/04/2017
Last updated
08/04/2017
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