Provider Demographics
NPI:1992763247
Name:SMITH, KIRSTEN ADELLE (RN MSN CNP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ADELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN MSN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 LILYDALE DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4044
Mailing Address - Country:US
Mailing Address - Phone:716-646-4506
Mailing Address - Fax:
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7737
Practice Address - Fax:716-888-3805
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420058363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health