Healthcare Provider Details

I. General information

NPI: 1285559484
Provider Name (Legal Business Name): KATHLYNN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLYNN GRIFFIN

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WALNUT ST
PHILADELPHIA PA
19107-5214
US

IV. Provider business mailing address

3 N CHRISTOPHER COLUMBUS BLVD APT 329
PHILADELPHIA PA
19106-1430
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-1533
  • Fax:
Mailing address:
  • Phone: 314-546-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: