Provider Demographics
NPI:1124791108
Name:SMITH, KIMBERLY (MSN, APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:497 W 400 N
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9227
Mailing Address - Country:US
Mailing Address - Phone:859-324-1638
Mailing Address - Fax:
Practice Address - Street 1:1115 ELKTON DR STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3597
Practice Address - Country:US
Practice Address - Phone:719-373-9703
Practice Address - Fax:877-588-3465
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010000163W00000X
IN71011556A363LP0808X
COC-APN.0003813-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse