Healthcare Provider Details

I. General information

NPI: 1730370719
Provider Name (Legal Business Name): KATHLEEN B SMITH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

1008 HALE RD
ELKINS AR
72727-2922
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-2500
  • Fax:
Mailing address:
  • Phone: 479-200-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberSTP-000007
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberS02222
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberAPN.0997240-CNS
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101340
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: