Provider Demographics
NPI:1083725428
Name:SMITH, KATHERINE T (CDE/NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:CDE/NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:TOSCANO-SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:205 E RIVER PARK CIR STE 460
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1585
Mailing Address - Country:US
Mailing Address - Phone:559-261-4500
Mailing Address - Fax:
Practice Address - Street 1:205 E RIVER PARK CIR STE 460
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-261-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411672163W00000X
CARN41672163WD0400X
CA14179363LF0000X
CANP14179363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMT1123455OtherDEA
CAMT1123455OtherDEA