Provider Demographics
NPI:1124328562
Name:SMITH, KRISTIE (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:
Other - Last Name:VANALSTYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:ROME VA CLINIC
Mailing Address - Street 2:125 BROOKLEY RD # 510
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-3397
Mailing Address - Country:US
Mailing Address - Phone:315-334-7100
Mailing Address - Fax:
Practice Address - Street 1:125 BROOKLEY RD # 510
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4301
Practice Address - Country:US
Practice Address - Phone:315-334-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5639841163W00000X
NY351943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse