Provider Demographics
NPI:1548803588
Name:SMITH, KRISTY
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 WILLOW TREE CIR STE 112
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3121
Mailing Address - Country:US
Mailing Address - Phone:901-571-2859
Mailing Address - Fax:
Practice Address - Street 1:879 WILLOW TREE CIR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3121
Practice Address - Country:US
Practice Address - Phone:901-571-2859
Practice Address - Fax:901-328-1259
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8091-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical