Provider Demographics
NPI:1083645881
Name:SMITH, KAMEO LYNNAE (DO)
Entity type:Individual
Prefix:DR
First Name:KAMEO
Middle Name:LYNNAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1311 N MILDRED RD
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2231
Mailing Address - Country:US
Mailing Address - Phone:970-564-8556
Mailing Address - Fax:
Practice Address - Street 1:1311A N MILDRED RD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321
Practice Address - Country:US
Practice Address - Phone:970-565-8556
Practice Address - Fax:970-564-1134
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-02131207Q00000X
CO40746207Q00000X
HIDOS-2381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI005626Medicaid
CO04974051Medicaid
341421805Medicare ID - Type Unspecified