KELLY SMITH NPI 1003005513

Licensed Vocational Nurse in Winchester, CA

About KELLY SMITH

Kelly Smith is a provider in Winchester, CA. The NPI number assigned to this provider is 1003005513. The practitioner's primary taxonomy code is Licensed Vocational Nurse (164X00000X). The provider is registered as an organization and their NPI record was last updated 6 years ago. Kelly Smith operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as Optimal Home Care & Staffing.

NPI1003005513 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameKELLY SMITH
Provider Location Address30724 BENTON RD C-302 #551 WINCHESTER, CA 92596 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address29970 TECHNOLOGY DR #208 MURRIETA, CA 92563 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Other Organization NameOPTIMAL HOME CARE & STAFFING Additional informationCallout TooltipProvider other organization name
The alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. Codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Other Name TypeDoing Business As (3)
Enumeration Date10-20-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date04-04-2012 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

KELLY SMITH
30724 BENTON RD
C-302 #551
WINCHESTER, CA
ZIP 92596
Phone: (951) 837-4703
Fax: (951) 837-4702
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Mailing Address

KELLY SMITH
29970 TECHNOLOGY DR
#208
MURRIETA, CA
ZIP 92563
Phone: (951) 837-4703
Fax: (951) 837-4702

Primary Taxonomy

Taxonomy Code164X00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationLicensed Vocational Nurse
TypeNursing Service Providers
License No.187389
License StateCA
Taxonomy DescriptionAn individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. [An alternate term for licensed practical nurse arising from difference in occupational titles between states and post-high school training programs and institutions.] Requirements for education, experience, licensure, and job responsibilities vary among the states.

Authorized Official

Authorized Official Name KELLY SMITH L.V.N. Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleNURSE
Authorized Official Phone(951) 837-4703

193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Map Location


KELLY SMITH address is 30724 BENTON RD C-302 #551 WINCHESTER, CA 92596