Healthcare Provider Details

I. General information

NPI: 1144365206
Provider Name (Legal Business Name): KRISTEN JANE SMITH MA, ATC, EMT(B)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ACADEMY ST
KALAMAZOO MI
49006-3268
US

IV. Provider business mailing address

5230 SHANE ST
KALAMAZOO MI
49009-7130
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-7090
  • Fax: 269-337-7401
Mailing address:
  • Phone: 268-372-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number3203002866
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: