Provider Demographics
NPI:1467605691
Name:KRISTIN N SMITH PLLC
Entity Type:Organization
Organization Name:KRISTIN N SMITH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C, RNFA
Authorized Official - Phone:602-524-1927
Mailing Address - Street 1:5303 W HACKAMORE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-4418
Mailing Address - Country:US
Mailing Address - Phone:623-266-2690
Mailing Address - Fax:623-337-4224
Practice Address - Street 1:5303 W HACKAMORE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-4418
Practice Address - Country:US
Practice Address - Phone:623-266-2690
Practice Address - Fax:623-337-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN104595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174598775OtherCURRENT INDIVIDUAL NPI NUMBER
AZ949894Medicaid
AZ949894Medicaid