Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 24-01269 | KS |
Y | 213ES0000X | Sports Medicine | 24-01269 | KS |
NPI | 1124529441 |
---|---|
Provider Name | Amanda F Smith |
First Address | Baldwin City, KS 66006-4202 |
Second Address | Baldwin City, KS 66006-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2018 |
Last Update Date | 22/02/2018 |