Provider Demographics
NPI:1528743564
Name:SMILEY, KIMBERLY L
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:SMILEY
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 1:1014 ROBERTA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-2721
Mailing Address - Country:US
Mailing Address - Phone:863-559-9449
Mailing Address - Fax:
Practice Address - Street 1:303 DR MARTIN LUTHER KING JR BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3647
Practice Address - Country:US
Practice Address - Phone:352-405-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist