Healthcare Provider Details

I. General information

NPI: 1922123389
Provider Name (Legal Business Name): KRISTIN KATHMAN SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN MARY KATHMAN PA-C

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE # C920B
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2139 AUBURN AVE # C920B
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-792-7445
  • Fax: 513-791-4042
Mailing address:
  • Phone: 513-792-7445
  • Fax: 513-791-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.001801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: