Kevin Etwood Smith Jr.

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Practice address

929 N Val Vista Dr Ste 109
Gilbert, AZ 85234-3701

Phone

(480) 862-3648

NPI assigned

Jun 21, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1718928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1790529923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 N ST PAUL",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852056864",
            "telephone_number": "480-862-3648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 N VAL VISTA DR STE 109",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852343701",
            "telephone_number": "480-862-3648"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1390 E Jasper Dr",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852964347",
            "country_code": "US",
            "telephone_number": "480-862-3648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KEVIN",
        "middle_name": "ETWOOD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-21",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Smith, M.D.
• Jennifer Smith, FNP-C
• Jennifer Marie Smith, OTD, OTR/L
• John Andrew Smith, RN
• Kerrie Nona Smith, SLPA
• Kevin Jon Smith, M.D.
• Kimberly Smith, SLPA
• Kimberly Lynne Smith, RN BSN IBCLC
• Kristine Ann Smith, OT
• Madison Smith

• Developmental Disabilities Clinic/Center in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Developmental Disabilities Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.