Provider Demographics
NPI:1427193846
Name:SMITH, KATHLEEN DOHERTY (RN, MS, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DOHERTY
Last Name:SMITH
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Gender:F
Credentials:RN, MS, FNP
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Other - First Name:
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Mailing Address - Street 1:875 BLAKE WILBUR DR
Mailing Address - Street 2:RM CC2342
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2205
Mailing Address - Country:US
Mailing Address - Phone:650-498-6335
Mailing Address - Fax:650-725-9113
Practice Address - Street 1:875 BLAKE WILBUR DR
Practice Address - Street 2:RM CC2342
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2205
Practice Address - Country:US
Practice Address - Phone:650-498-6335
Practice Address - Fax:650-725-9113
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CARN405035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily