Provider Demographics
NPI:1093815318
Name:SMITH, KATHLEEN L (ARNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W D AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1266
Mailing Address - Country:US
Mailing Address - Phone:620-532-0295
Mailing Address - Fax:855-493-0002
Practice Address - Street 1:750 W D AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1266
Practice Address - Country:US
Practice Address - Phone:620-532-0295
Practice Address - Fax:855-493-0002
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161589Medicare PIN