Provider Demographics
NPI:1841433513
Name:SMITH, KATHRYN O (DNP, APRN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:O
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, APRN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 SILVERTHORN DR NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1062
Mailing Address - Country:US
Mailing Address - Phone:914-522-7603
Mailing Address - Fax:
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-881-8020
Practice Address - Fax:678-539-3080
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA173666363LA2100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse