Kelly O Smith, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002588 Issued in CT

Practice address

111 Salem Tpke Ste 7
Norwich, CT 06360-7403

Phone

(860) 859-2262

Fax

(860) 859-9819

NPI assigned

Jul 16, 2011

Last updated

Jan 23, 2025By the provider in NPPES

Sex

Female

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

Enrolled in CT

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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology LLCGroup PAC ID 5092706945, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Advanced Dermatology LLC

  • Dermatology Physician
  • Norwich, CT
  • NPI 1609892298
  Medicare reassignment Care Compare group
• Interanal Medicine and Pediatric Associates LLC

  • Internal Medicine Physician
  • Enfield, CT
  • NPI 1124117908
  NPD (past)

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

{
    "created_epoch": "1310774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1851689467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 SALEM TPKE STE 7",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063607403",
            "telephone_number": "860-859-2262",
            "fax_number": "860-859-9819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SALEM TPKE STE 7",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063607403",
            "telephone_number": "860-859-2262",
            "fax_number": "860-859-9819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "O",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-16",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie Ellen Smith, PHLEBOTOMIST
• Cathryn Quenna Smith
• Derek R Smith, MD
• Diane Smith, LCSW
• Julie C Smith, LCSW
• Lisa Smith
• Maryann E Smith, MD
• Michael Smith, PHARM.D.
• Michael Lee Smith Jr.
• Monica Tari Smith, LMFT

• Physician Assistant in Norwich, CT
• Providers in Norwich, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.