Healthcare Provider Details

I. General information

NPI: 1144889718
Provider Name (Legal Business Name): KATHERINE SMITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 MEDICAL ARTS ST STE 2
AUSTIN TX
78705-3331
US

IV. Provider business mailing address

3601 4TH ST
LUBBOCK TX
79430-0002
US

V. Phone/Fax

Practice location:
  • Phone: 512-391-0175
  • Fax:
Mailing address:
  • Phone: 806-743-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberU4019
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: