Healthcare Provider Details

I. General information

NPI: 1124328562
Provider Name (Legal Business Name): KRISTIE SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE VANALSTYNE RN

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 1ST ST
OSWEGO NY
13126-2111
US

IV. Provider business mailing address

61 DELANO ST
PULASKI NY
13142-1400
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-0880
  • Fax:
Mailing address:
  • Phone: 315-298-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351943
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5639841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: