Healthcare Provider Details

I. General information

NPI: 1992763247
Provider Name (Legal Business Name): KIRSTEN ADELLE SMITH RN MSN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

4730 LILYDALE DR
HAMBURG NY
14075-4044
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7737
  • Fax: 716-888-3805
Mailing address:
  • Phone: 716-646-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420058
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: