Healthcare Provider Details

I. General information

NPI: 1194357749
Provider Name (Legal Business Name): KRISTEN DANIEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN SMITH

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 E NIZHONI BLVD
GALLUP NM
87301-5757
US

IV. Provider business mailing address

825 N 60 E
AMERICAN FORK UT
84003-1217
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-6603
  • Fax: 505-722-6111
Mailing address:
  • Phone: 714-915-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number87511
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7964749-4409
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: