Provider Demographics
NPI:1457769556
Name:SMITH, KRISTEN BETH (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:BETH
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2065 HERSCHEL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3817
Mailing Address - Country:US
Mailing Address - Phone:904-387-4050
Mailing Address - Fax:904-387-4860
Practice Address - Street 1:2065 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3817
Practice Address - Country:US
Practice Address - Phone:904-387-4050
Practice Address - Fax:904-387-4860
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9321135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily