Provider Demographics
NPI:1235119132
Name:SMITH, KRISTA (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W BROADWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9045
Mailing Address - Country:US
Mailing Address - Phone:712-325-1990
Mailing Address - Fax:712-325-0288
Practice Address - Street 1:300 W BROADWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9045
Practice Address - Country:US
Practice Address - Phone:712-325-1990
Practice Address - Fax:712-325-0288
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-060898363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38978OtherWELLMARK BCBS
IA0188946Medicaid
IAS57430Medicare UPIN
IA38978OtherWELLMARK BCBS