Individual
MR. KELLY B. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9100 W 74TH ST, SHAWNEE MISSION, KS 66204-4004
(913) 632-2230
(913) 632-2297
Mailing address
PO BOX 411895, KANSAS CITY, MO 64141-1895
(913) 632-2230
(913) 632-2297
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1482828061
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
55125
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100457780A
—
KS
01
—
32813018
BCBS KC
KS
05
—
918965401
—
MO
01
—
P00032006
RR MEDICARE
KS
Enumeration date
03/02/2006
Last updated
11/24/2020
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