Provider Demographics
NPI:1124867239
Name:SMITH, KERRY-ANN TAMEKA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KERRY-ANN
Middle Name:TAMEKA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 NE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-3209
Mailing Address - Country:US
Mailing Address - Phone:561-324-4302
Mailing Address - Fax:
Practice Address - Street 1:10571 BEXLEY BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1210
Practice Address - Country:US
Practice Address - Phone:561-926-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032889363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health