Provider Demographics
NPI:1720343999
Name:SMITH, KRISTEN MICHELE (BS HUMAN SERVICES)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MICHELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS HUMAN SERVICES
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:MICHELE
Other - Last Name:FARRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS HUMAN SERVICES
Mailing Address - Street 1:200 AVENUE F NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3904
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator