Provider Demographics
NPI:1326475476
Name:SMITH, KURTIS RUSSELL (FNP)
Entity Type:Individual
Prefix:MR
First Name:KURTIS
Middle Name:RUSSELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2086 N 1700 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1164
Mailing Address - Country:US
Mailing Address - Phone:801-773-8644
Mailing Address - Fax:801-927-1591
Practice Address - Street 1:2086 N 1700 W
Practice Address - Street 2:SUITE C
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1164
Practice Address - Country:US
Practice Address - Phone:801-773-8644
Practice Address - Fax:801-927-1591
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6216136-4405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics