Provider Demographics
NPI:1427600790
Name:SMITH, KRISTY MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:MARIE
Other - Last Name:MINIARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10619 HIGHWAY 987
Mailing Address - Street 2:
Mailing Address - City:SMITH
Mailing Address - State:KY
Mailing Address - Zip Code:40831-5420
Mailing Address - Country:US
Mailing Address - Phone:606-273-2239
Mailing Address - Fax:
Practice Address - Street 1:3503 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2611
Practice Address - Country:US
Practice Address - Phone:606-242-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily