Provider Demographics
NPI:1972173698
Name:SMITH, KYLE EVERETT (DNP-CRNA)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:EVERETT
Last Name:SMITH
Suffix:
Gender:M
Credentials:DNP-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9274 N 1400 BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-4598
Mailing Address - Country:US
Mailing Address - Phone:812-664-3182
Mailing Address - Fax:
Practice Address - Street 1:1418 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-2638
Practice Address - Country:US
Practice Address - Phone:618-262-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023445367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered