Provider Demographics
NPI:1568563120
Name:SMITH, KRISTINA RUTH (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:RUTH
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:R
Other - Last Name:SIGSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2210 SUTHERLAND AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-525-4333
Mailing Address - Fax:865-212-8879
Practice Address - Street 1:2210 SUTHERLAND AVE
Practice Address - Street 2:STE 110
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-525-4333
Practice Address - Fax:865-212-8879
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0139OtherJOHN DEERE HEALTHCARE
TN3644896Medicaid
3644896Medicare PIN
TN3644896Medicaid
Q75696Medicare UPIN