Healthcare Provider Details

I. General information

NPI: 1184556573
Provider Name (Legal Business Name): CHRISTINA KATHRYN SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

2966 SHORELINE CIR
FAIRFIELD CA
94533-7045
US

V. Phone/Fax

Practice location:
  • Phone: 972-974-1689
  • Fax:
Mailing address:
  • Phone: 972-974-1689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1063869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: