1366751794 NPI number — MRS. KELLY SUE SMITH VERNON M.A.

Table of content: MRS. KELLY SUE SMITH VERNON M.A. (NPI 1366751794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366751794 NPI number — MRS. KELLY SUE SMITH VERNON M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH VERNON
Provider First Name:
KELLY
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366751794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 PLEASANT HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLIPOLIS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45631-9074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-379-9175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4836 STATE ROUTE 325
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATRIOT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45658-8960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-379-9085
Provider Business Practice Location Address Fax Number:
740-379-9138
Provider Enumeration Date:
10/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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