Provider Demographics
NPI:1275320699
Name:SMITH, KRISTINA S
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:S
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:S
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-1413
Mailing Address - Country:US
Mailing Address - Phone:614-928-7541
Mailing Address - Fax:
Practice Address - Street 1:917 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2042
Practice Address - Country:US
Practice Address - Phone:614-928-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide