Provider Demographics
NPI:1164645024
Name:SMOTHERS, KATHLEEN ANNE (RN,MSN,APN-BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:RN,MSN,APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 GYPSY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-9715
Mailing Address - Country:US
Mailing Address - Phone:828-652-8196
Mailing Address - Fax:828-652-8186
Practice Address - Street 1:59 GYPSY MOUNTAIN RD.
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4527
Practice Address - Country:US
Practice Address - Phone:828-652-8196
Practice Address - Fax:828-652-8186
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900271363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health