Individual ProviderKeeanna SmithStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address128 E Apple St, 2nd Floor, Dayton, OH 45409-2902(937) 208-2004PECOS EnrollmentBased on the most recent information from CMS, provider Keeanna Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 1:10 PM.Profile DetailsProvider ID1710410204Provider TypeIndividualFull NameSmith, KeeannaGenderFemaleSole ProprietorNoEnumeration Date4/11/2017Last Updated8/12/2021Contact InformationPractice LocationPractice Address128 E Apple St, 2nd Floor, Dayton, OH 45409-2902Phone(937) 208-2004Fax(937) 208-8828Mailing LocationMailing Address128 E Apple St, 2nd Floor, Dayton, OH 45409-2902PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense35.140694Ohio