Individual
KELLY A SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
5501 MARVIN SHIELDS BLVD, GULFPORT, MS 39501-9007
(228) 871-2810
Mailing address
3150 HOLLOWAY DR, GULFPORT, MS 39501-9030
(228) 871-2810
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/29/2008
Last updated
07/29/2008
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