Provider Demographics
NPI:1922123389
Name:SMITH, KRISTIN KATHMAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KATHMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARY
Other - Last Name:KATHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2139 AUBURN AVE # C920B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-792-7445
Mailing Address - Fax:513-791-4042
Practice Address - Street 1:2139 AUBURN AVE # C920B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-792-7445
Practice Address - Fax:513-791-4042
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001801363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH079710Medicare PIN