Individual provider Active NPI

Kelly Ann Smith, PNP

  • Nurse Practitioner
  • Buffalo, NY
National Provider Identifier
1053589846
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
381855 Issued in NY
Practice address
Elm and Carlton St
Buffalo, NY 14263-2027
Phone
(716) 845-2300
NPI assigned
Feb 14, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 381855 NY Primary

Addresses

Primary practice location

Elm and Carlton St
Buffalo, NY 14263-2027

Mailing address

63 Shenandoah Rd
Buffalo, NY 14220-2417
Phone (716) 435-8636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090506000284 NY Practitioner - Nurse Practitioner 2860540598 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
381855NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Roswell Park Cancer Institute CurrentSince Jul 1, 2025 Accepting new patients
Roswell Park Cancer Institute CurrentSince Jul 1, 2025 Accepting new patients
Kaleida Health CurrentSince May 12, 2020 Accepting new patients
Kaleida Health CurrentSince May 12, 2020 Accepting new patients
Kaleida Health Current Accepting new patients
University at Buffalo Pediatric Associates Inc PastSince Jan 1, 1998 Accepting new patients
Buffalo Pediatric Associates LLP Past Accepting new patients

Locations

Dept 8000
Buffalo, NY 14267

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

900 Hertel Ave
Buffalo, NY 14216
Phone (716) 871-1571

Elm and Carlton St
Buffalo, NY 14263

818 Ellicott St
Buffalo, NY 14203
Phone (716) 323-2000

445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1053589846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 SHENANDOAH RD",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142202417",
            "telephone_number": "716-435-8636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ELM AND CARLTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142632027",
            "telephone_number": "716-845-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-14",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "381855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.