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:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:HANA
Mailing Address - State:HI
Mailing Address - Zip Code:96713-0717
Mailing Address - Country:US
Mailing Address - Phone:828-385-6587
Mailing Address - Fax:
Practice Address - Street 1:4590 HANA HWY
Practice Address - Street 2:
Practice Address - City:HANA
Practice Address - State:HI
Practice Address - Zip Code:96713
Practice Address - Country:US
Practice Address - Phone:808-248-8294
Practice Address - Fax:808-248-7223
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-12-26
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