Healthcare Provider Details

I. General information

NPI: 1326966656
Provider Name (Legal Business Name): KATE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 KEIDEL TRL SW
MANDAN ND
58554-2360
US

IV. Provider business mailing address

704 KEIDEL TRL SW
MANDAN ND
58554-2360
US

V. Phone/Fax

Practice location:
  • Phone: 701-301-4162
  • Fax:
Mailing address:
  • Phone: 701-301-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: