Provider Demographics
NPI:1891770442
Name:SMITH, KATHRYN EVANS (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EVANS
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 WINDING WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5835
Mailing Address - Country:US
Mailing Address - Phone:727-785-5394
Mailing Address - Fax:727-785-6314
Practice Address - Street 1:148 13TH ST SW
Practice Address - Street 2:#200
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3127
Practice Address - Country:US
Practice Address - Phone:727-450-3030
Practice Address - Fax:727-450-3031
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1859422367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1033OtherBCBS
FL302960300Medicaid
P00013477OtherRAILROAD MEDICARE
FL302960300Medicaid