Provider Demographics
NPI:1588421440
Name:SMITH, KODI ANN (QBA)
Entity type:Individual
Prefix:
First Name:KODI
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10614 SHINY SKIES DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-4603
Mailing Address - Country:US
Mailing Address - Phone:907-982-9019
Mailing Address - Fax:
Practice Address - Street 1:7375 PRAIRIE FALCON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0809
Practice Address - Country:US
Practice Address - Phone:725-205-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst