Provider Demographics
NPI:1306636402
Name:SMITH, KELSEY JUNE (RN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JUNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 CREST RD
Mailing Address - Street 2:
Mailing Address - City:EAST FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28726-2250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:423 CREST RD
Practice Address - Street 2:
Practice Address - City:EAST FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28726-2250
Practice Address - Country:US
Practice Address - Phone:828-808-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC272681163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse