Provider Demographics
NPI:1518096759
Name:SMITH, KIMBERLY A (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 BROTHERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13480-1711
Mailing Address - Country:US
Mailing Address - Phone:315-841-8226
Mailing Address - Fax:
Practice Address - Street 1:210 OLD CAMPION RD
Practice Address - Street 2:MOHAWK VALLEY PLASTIC RECONSTRUCTIVE SURGERY
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1635
Practice Address - Country:US
Practice Address - Phone:315-266-0407
Practice Address - Fax:315-266-0410
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY501056163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse