Provider Demographics
NPI:1952605040
Name:SMITH, KRISTEN DIONNE (RN)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:DIONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 HEATHROW CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7750
Mailing Address - Country:US
Mailing Address - Phone:678-983-9402
Mailing Address - Fax:
Practice Address - Street 1:4505 HEATHROW CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7750
Practice Address - Country:US
Practice Address - Phone:678-983-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN185395163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse