Healthcare Provider Details

I. General information

NPI: 1043977929
Provider Name (Legal Business Name): KATHERINE ANNE SMITH DNP, RN, ACCNS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

1831 ADDISON ST
PHILADELPHIA PA
19146-1401
US

V. Phone/Fax

Practice location:
  • Phone: 267-443-8768
  • Fax:
Mailing address:
  • Phone: 717-725-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberCNS000384
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN669743
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: