MEDICARE: KATHERINE T SMITH CDE/NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	411672	CA
2	163WD0400X	Diabetes Educator Registered Nurse	RN41672	CA
3	363LF0000X	Family Nurse Practitioner	14179	CA
4	363L00000X	Nurse Practitioner	NP14179	CA

General Provider Information

NPI Number	:	1083725428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE T SMITH CDE/NP

Provider Business Mailing Address
First Line	:	205 E RIVER PARK CIR STE 460
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-1585
Country	:	US
Telephone Number	:	559-261-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 E RIVER PARK CIR STE 460
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720
Country	:	US
Telephone Number	:	559-261-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/07/2023

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