Healthcare Provider Details

I. General information

NPI: 1871417162
Provider Name (Legal Business Name): KIMBERLY A SMITH REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 W 6TH AVE
AIRWAY HEIGHTS WA
99001-5345
US

IV. Provider business mailing address

6275 E FRENCH GULCH RD
COEUR D ALENE ID
83814-7755
US

V. Phone/Fax

Practice location:
  • Phone: 509-481-4990
  • Fax:
Mailing address:
  • Phone: 541-921-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number3081734
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number69408
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: