Healthcare Provider Details

I. General information

NPI: 1164058269
Provider Name (Legal Business Name): KAYLEE ANN KRIGEST SMITH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-1931
US

IV. Provider business mailing address

1 ESSEX CENTER DR
PEABODY MA
01960-2901
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax:
Mailing address:
  • Phone: 978-538-4680
  • Fax: 978-538-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2306866
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2306866
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: