KENDRA MAE BLACK-SMITH (NPI# 1790866044) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790866044 |
| Entity Type | Individual |
| Full Name | KENDRA MAE BLACK-SMITH |
| Other Name | KENDRA M SMITH |
| Credential | MD |
| Practice Address |
2003 Kootenai Health Way Coeur D Alene ID 83814 |
| Mailing Address |
2003 Kootenai Health Way Coeur D Alene ID 83814-6051 |
| Practice Telephone | 2086255185 |
| Practice Fax Number | 2086256892 |
| Mailing Telephone | 2086255059 |
| Mailing Fax Number | 2086255731 |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-04-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
M14495 | ID | Allopathic & Osteopathic Physicians |
| N | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
MD00039197 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 8269235 | 05 | |
| INTERNAL ID-MOTOR VEHICLE ID | 272030 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4800 Sand Point Way Ne, Seattle, WA 981053901 | 2069872000 |
| Street Address |
2003 KOOTENAI HEALTH WAY |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912909151 | Pamela S Pomeroy | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814 | 2005-06-01 |
| 1104425149 | Denise White | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2020-10-21 |
| 1992343487 | Audrey Nordness | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-12-15 |
| 1881245017 | Jackie Rae Fitting | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-29 |
| 1336790567 | Shane Oliver Withers Jr. | Pharmacist | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-29 |
| 1447800552 | Keith Mccullough | Physician Assistant | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-19 |
| 1568012102 | Kaitlin Wendt | Nurse Practitioner | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-16 |
| 1215586862 | Heather A Hamilton | Social Worker | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-09-06 |
| 1205498193 | Guy Hoenke | Registered Nurse | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-07-01 |
| 1407417843 | Maddison M Ray | Dietitian, Registered | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2019-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316191976 | Brook Yuknis Lang | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814 | 2008-11-10 |
| 1427222868 | Lisa Lynn Mcgill-vargas | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814 | 2008-04-16 |
| 1083825509 | Maggie Chen | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814 | 2007-05-25 |
| 1619018470 | Kimberly Judd | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2007-02-12 |
| 1396832846 | Bonnie Stephens | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2006-10-06 |
| 1861464406 | Robert Paul Englert | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814 | 2006-02-07 |
| 1083605976 | Kara Lynn Arvin | Pediatrics | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2005-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144269747 | Stewart Lawrence | Pediatrics | 6030 W Emerald St, Boise, ID 83704-8855 | 2006-06-06 |
| 1114346749 | Jordan Simpson | Pediatrics | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2014-04-10 |
| 1619263563 | Timothy J Ulrich | Pediatrics | 801 Pole Line Rd W, Twin Falls, ID 83301-5810 | 2011-06-20 |
| 1710277215 | Shelly Haug | Pediatrics | 3100 Channing Way, Idaho Falls, ID 83404 | 2011-04-18 |
| 1790939056 | Neonatal Associates, Pllc | Pediatrics | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2008-11-12 |
| 1780870360 | Nathan L Thornton | Pediatrics | 190 E Bannock St, Boise, ID 83712-6241 | 2007-09-18 |
| 1558495796 | James W Vanlooy | Pediatrics | 190 E Bannock St, Boise, ID 83712-6241 | 2007-03-16 |
| 1285786046 | Patients First Neonatology LLC | Pediatrics | 3100 Channing Way, Idaho Falls, ID 83404-7533 | 2007-01-18 |
| 1598828378 | Erik N Meyers | Pediatrics | 190 E Bannock St, Boise, ID 83712-6241 | 2006-12-19 |
| 1629000716 | Scott A Snyder | Pediatrics | 190 E Bannock St, Boise, ID 83712-6241 | 2006-07-07 |
| Find all providers with the same taxonomy | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.