Provider Demographics
NPI:1346979143
Name:SMITHERMAN, KEVYN MARIE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KEVYN
Middle Name:MARIE
Last Name:SMITHERMAN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:KEVYN
Other - Middle Name:MARIE
Other - Last Name:LORAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 INTERCHANGE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2084
Mailing Address - Country:US
Mailing Address - Phone:701-490-9596
Mailing Address - Fax:
Practice Address - Street 1:1500 INTERCHANGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2084
Practice Address - Country:US
Practice Address - Phone:701-490-9596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR43339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily