Individual
KENA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2612 LAMOTT AVE, WILLOW GROVE, PA 19090-4411
(267) 982-8851
Mailing address
8470 LIMEKILN PIKE APT 318, WYNCOTE, PA 19095-2720
(267) 982-8851
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
PA
Enumeration date
04/26/2021
Last updated
04/26/2021
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