Provider Demographics
NPI:1487139937
Name:SMOTHERMAN, KANIYA KASHELL
Entity type:Individual
Prefix:
First Name:KANIYA
Middle Name:KASHELL
Last Name:SMOTHERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 SCIECEHILL DR.
Mailing Address - Street 2:
Mailing Address - City:ST.LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137
Mailing Address - Country:US
Mailing Address - Phone:314-489-8686
Mailing Address - Fax:
Practice Address - Street 1:3834A COTEBRILLIANTE AVE.
Practice Address - Street 2:
Practice Address - City:ST LOUIS , MO
Practice Address - State:MO
Practice Address - Zip Code:63113
Practice Address - Country:US
Practice Address - Phone:314-489-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care