Kenneth Warren Smith Sr., APA-C

Key facts

NPI

1700969649

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

Practice address

1 Jarrett White Rd
Tripler Army Medical Center Attn: MCHK-QS
Tamc, HI 96859-5001

Phone

(808) 433-2460

Fax

(808) 433-1558

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 22, 2015.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445472000000",
    "number": "1700969649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8901 ROCKVILLE PIKE",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208890001",
            "telephone_number": "301-400-2846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "address_2": "TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS",
            "city": "TAMC",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-2460",
            "fax_number": "808-433-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KENNETH",
        "middle_name": "WARREN",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "APA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2015-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tamc, HI

• Taylor Lee Sawyer, D.O.
• David Gordon Schall, MD
• James Randal Sellars, CRNA
• Renwick G Serna, PHARM.D
• Aparna Sharad Shah, M.D.
• Felix Song, MD
• William Richardson Spalding, RN
• Jeffrey Peter Stolrow, PH.D.
• Michael Emil Stoudmire, D.O
• Brad Strumwasser

All providers in Tamc, HI · Physician Assistant in Hawaii