Provider Demographics
NPI:1902445679
Name:SMITH, KATIE L (APRN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4410
Mailing Address - Country:US
Mailing Address - Phone:315-800-3213
Mailing Address - Fax:301-238-7842
Practice Address - Street 1:2808 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4410
Practice Address - Country:US
Practice Address - Phone:315-800-3213
Practice Address - Fax:301-238-7842
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590699367A00000X
GARN298822367A00000X
FL11005940367A00000X
FLAPRN11005940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife