Healthcare Provider Details

I. General information

NPI: 1922759760
Provider Name (Legal Business Name): KRISTY SMITH APRN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 W SAHARA AVE STE 202
LAS VEGAS NV
89146-0361
US

IV. Provider business mailing address

9101 ALTA DR UNIT 1205
LAS VEGAS NV
89145-8541
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-8200
  • Fax:
Mailing address:
  • Phone: 702-325-2577
  • Fax: 702-380-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTY SMITH
Title or Position: MANAGER
Credential: APRN
Phone: 702-325-2577