Healthcare Provider Details

I. General information

NPI: 1235135591
Provider Name (Legal Business Name): KATHLEEN J SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY J CRUMP ARNP

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 COLORADO BLVD
DENTON TX
76210-6817
US

IV. Provider business mailing address

3319 COLORADO BLVD
DENTON TX
76210-6817
US

V. Phone/Fax

Practice location:
  • Phone: 940-383-1279
  • Fax: 940-387-0489
Mailing address:
  • Phone: 940-383-1279
  • Fax: 940-387-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP119931
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA03000 ANP
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP119931
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006856
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number550735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: