Provider Demographics
NPI:1407860182
Name:SMITH, KRISTIE D (ARNP)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:544 BRAWLEY SCHOOL RD
Mailing Address - Street 2:STE A
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9393
Mailing Address - Country:US
Mailing Address - Phone:606-573-4440
Mailing Address - Fax:606-573-4441
Practice Address - Street 1:544 BRAWLEY SCHOOL RD
Practice Address - Street 2:STE A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9393
Practice Address - Country:US
Practice Address - Phone:606-573-4440
Practice Address - Fax:606-573-4441
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004931363LF0000X
NC5011421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78017019Medicaid
KY78017019Medicaid