Kelly Wayne Smith, NP FNP-PP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Practice address

Bay Clinic, LLP
1750 Thompson Rd
Coos Bay, OR 97420

Phone

(541) 269-0333

NPI assigned

Apr 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508083189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BAY CLINIC, LLP",
            "address_2": "1750 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "97420",
            "telephone_number": "541-269-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BAY CLINIC, LLP",
            "address_2": "1750 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "97420",
            "telephone_number": "541-269-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "WAYNE",
        "credential": "NP FNP-PP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim L Slight, M.D.
• Sarah Jane Sluder
• Jonathan Thomas Small, DPT
• Bernadette Frances Smith, ADULT FOSTER CARE PR
• Jeanne Smith, LCSW
• Mandy D. Smith
• Maria Socorro Miel Smith, PT
• Megan Smith, PA-C
• Melissa Marie Smith, CSWA, QMHP-R
• Rose Marie Smith, RN

• Adult Health Nurse Practitioner in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Adult Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.