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Provider Information for 1699235440


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KIMBERLY SMITH


Sex: Female

NPI: 1699235440
Last Updated: 2019-03-20
Certification Date:

Details

NameValue
NPI1699235440
Enumeration Date2019-03-20
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 1672 COLUMBIA HWY
DOTHAN, AL 36303-5434
United States

Phone: 334-712-2673 | Fax:
 
Primary Practice Address 1672 COLUMBIA HWY
DOTHAN, AL 36303-5434
United States

Phone: 334-712-2673 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Direct Messaging Address
Kims@spectracare.org
Email
Direct 1672 Columbia Hwy
Dothan, AL 36303-5434
United States
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalAL4056