Individual
KENDRA MAE BLACK-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814
(208) 625-5185
(208) 625-6892
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5059
(208) 625-5731
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
M14495
ID
2080N0001X
Neonatal-Perinatal Medicine Physician
MD00039197
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
272030
INTERNAL ID-MOTOR VEHICLE ID
—
05
—
8269235
—
WA
Enumeration date
10/17/2006
Last updated
04/03/2019
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