Provider Demographics
NPI:1427723634
Name:SMITH, KRYSTAL MARIE (MSN, APRN, CNM)
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-9071
Mailing Address - Country:US
Mailing Address - Phone:859-620-2982
Mailing Address - Fax:
Practice Address - Street 1:606 BRANCH CT
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-9071
Practice Address - Country:US
Practice Address - Phone:859-620-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016387367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty