Provider Demographics
NPI:1881744886
Name:SMITH, KRISTY
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 ALTA DR UNIT 1205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8541
Mailing Address - Country:US
Mailing Address - Phone:702-325-1577
Mailing Address - Fax:702-380-3220
Practice Address - Street 1:5440 W SAHARA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0361
Practice Address - Country:US
Practice Address - Phone:702-380-8200
Practice Address - Fax:702-380-3220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000926363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health