Provider Demographics
NPI:1275262131
Name:KINGSMITH, SAVANNAH NICHOLE (CNM)
Entity type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:NICHOLE
Last Name:KINGSMITH
Suffix:
Gender:
Credentials:CNM
Other - Prefix:DR
Other - First Name:SAVANNAH
Other - Middle Name:NICHOLE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CNM
Mailing Address - Street 1:112 LA CASA VIA STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3059
Mailing Address - Country:US
Mailing Address - Phone:925-239-0012
Mailing Address - Fax:925-239-0011
Practice Address - Street 1:112 LA CASA VIA STE 300
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3059
Practice Address - Country:US
Practice Address - Phone:925-239-0012
Practice Address - Fax:925-239-0011
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236260367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife