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General NPI Number Information
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NPI Number | 1083034946
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Entity Type | Individual
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Provider Name | KAITLYN SMITH
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Gender | Female
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 765 ROUTE 10 E STE 201
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City | RANDOLPH
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State | NJ
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Zip | 07869-1925
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Country | US
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Telephone | 973-479-1128
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Fax |
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Provider Business Mailing Address
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Address Line | 105 RAIDER BLVD SUITE 101
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1528
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Country | US
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Telephone | 973-479-1129
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00498600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ00498600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 26NJ00498600
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License Number State | NJ
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