Healthcare Provider Details

I. General information

NPI: 1801396213
Provider Name (Legal Business Name): KRISTEN NICOLE SMITH RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 SCOGIN DR
MONTICELLO AR
71655-5729
US

IV. Provider business mailing address

778 SCOGIN DR
MONTICELLO AR
71655-5729
US

V. Phone/Fax

Practice location:
  • Phone: 870-460-3509
  • Fax: 870-460-3528
Mailing address:
  • Phone: 870-460-3509
  • Fax: 870-460-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR081878
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: