Healthcare Provider Details

I. General information

NPI: 1477799484
Provider Name (Legal Business Name): KRISTINE ANNE SMITH ACNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 ILLINOIS AVE
FT. LEONARD WOOD MO
65473
US

IV. Provider business mailing address

4234 ILLINOIS AVE
FT. LEONARD WOOD MO
65473
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-0035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2023028677
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4424
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number212761
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number16690
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2023028678
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: