Healthcare Provider Details

I. General information

NPI: 1689042442
Provider Name (Legal Business Name): KIMBERLEY RUTH SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 TERRACE ST
MEADVILLE PA
16335-1737
US

IV. Provider business mailing address

625 GRANDVIEW ROAD
ELWOOD CITY PA
16117
US

V. Phone/Fax

Practice location:
  • Phone: 814-373-2976
  • Fax: 814-333-7071
Mailing address:
  • Phone: 724-944-0381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP016149
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: