Provider Demographics
NPI:1659913721
Name:SMITH, KRISTIN S
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
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 1:100 TRICIA LN APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2701
Mailing Address - Country:US
Mailing Address - Phone:434-594-2171
Mailing Address - Fax:
Practice Address - Street 1:516 THORNCLIFF DR APT 101
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-8757
Practice Address - Country:US
Practice Address - Phone:434-594-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide