Provider Demographics
NPI:1316130990
Name:SMEDLEY, KELLY L (PMHCNS-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:SMEDLEY
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 HIGHGATE DR STE 231
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6631
Mailing Address - Country:US
Mailing Address - Phone:919-275-1405
Mailing Address - Fax:
Practice Address - Street 1:5318 HIGHGATE DR STE 231
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6631
Practice Address - Country:US
Practice Address - Phone:919-275-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214974364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult