Healthcare Provider Details

I. General information

NPI: 1235119132
Provider Name (Legal Business Name): KRISTA SMITH A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BROADWAY SUITE 6
COUNCIL BLUFFS IA
51503-9045
US

IV. Provider business mailing address

300 W BROADWAY SUITE 6
COUNCIL BLUFFS IA
51503-9045
US

V. Phone/Fax

Practice location:
  • Phone: 712-325-1990
  • Fax: 712-325-0288
Mailing address:
  • Phone: 712-325-1990
  • Fax: 712-325-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA-060898
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: