Provider Demographics
NPI:1386314581
Name:SMITH, KARA (FNP-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6960
Mailing Address - Country:US
Mailing Address - Phone:989-631-6730
Mailing Address - Fax:989-631-4398
Practice Address - Street 1:3016 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6960
Practice Address - Country:US
Practice Address - Phone:989-631-6730
Practice Address - Fax:989-631-4398
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-18
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704345113363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
336088OtherALPP ID