Provider Demographics
NPI:1063260131
Name:SMITH, KATE M (APN)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 YARD RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-1011
Mailing Address - Country:US
Mailing Address - Phone:908-283-4242
Mailing Address - Fax:
Practice Address - Street 1:100 CHALLENGER RD # 205
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-2108
Practice Address - Country:US
Practice Address - Phone:443-383-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15038800363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology