Provider Demographics
NPI:1669787032
Name:SMITH, KENNETH MONDRE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MONDRE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:9652 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6322
Mailing Address - Country:US
Mailing Address - Phone:346-719-6880
Mailing Address - Fax:713-464-6804
Practice Address - Street 1:9652 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6322
Practice Address - Country:US
Practice Address - Phone:346-719-6880
Practice Address - Fax:713-464-6804
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06722363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical