Healthcare Provider Details

I. General information

NPI: 1043623259
Provider Name (Legal Business Name): KAITLYN SMITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CARLISLE ST
NATRONA HEIGHTS PA
15065
US

IV. Provider business mailing address

711 ONONDAGA CIR
MARS PA
16046-4073
US

V. Phone/Fax

Practice location:
  • Phone: 724-224-5100
  • Fax:
Mailing address:
  • Phone: 412-418-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLP03141
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS018972
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: