Basic Information
| Provider Information | |||||||||
| NPI: | 1497753297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KAY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2751 BAY PARK DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436164921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196907596 | ||||||||
| FaxNumber: | 4196976707 | ||||||||
| Practice Location | |||||||||
| Address1: | 2751 BAY PARK DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436164921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196907596 | ||||||||
| FaxNumber: | 4196976707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 04991 | OH | N | Other Service Providers | Midwife | 367A00000X | NM04991 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LW0102X | NP02845 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 05225 | 01 | OH | PARAMOUNT | OTHER | 2016740 | 05 | OH | MEDICAID | 4091925 | 05 | MI | MEDICAID | 344428256 | 01 | OH | BEECHSTREET | OTHER | 344428256074 | 01 | OH | CARESOURCE | OTHER | 000000064890 | 01 | OH | ANTHEM | OTHER | 344428256 | 01 | OH | FRONTPATH | OTHER |