Provider Demographics
NPI:1154174423
Name:SMITH, KIMBERLY ANN (CSFA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2452 CROWE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:SC
Mailing Address - Zip Code:29685-1812
Mailing Address - Country:US
Mailing Address - Phone:708-372-6446
Mailing Address - Fax:
Practice Address - Street 1:24 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4452
Practice Address - Country:US
Practice Address - Phone:644-788-7488
Practice Address - Fax:864-708-0897
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant