Provider Demographics
NPI:1356485726
Name:PATTISON SMITH, KRISTIE PEACE (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:PEACE
Last Name:PATTISON SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:PEACE
Other - Last Name:PATTISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 204097
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-4097
Mailing Address - Country:US
Mailing Address - Phone:706-466-4541
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-855-9860
Practice Address - Fax:706-860-7124
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1083329367500000X
SCR 84401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse