Healthcare Provider Details

I. General information

NPI: 1043589849
Provider Name (Legal Business Name): KIMBERLY SMITH NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-1629
US

IV. Provider business mailing address

601 ELMWOOD AVE
ROCHESTER NY
14642-0002
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2267
  • Fax:
Mailing address:
  • Phone: 585-275-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number571761
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number350346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: