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General NPI Number Information
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NPI Number | 1124328562
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Entity Type | Individual
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Provider Name | KRISTIE SMITH FNP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 125 BROOKLEY RD # 510
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City | ROME
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State | NY
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Zip | 13441-4301
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Country | US
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Telephone | 315-334-7100
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Fax |
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Provider Business Mailing Address
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Address Line | ROME VA CLINIC 125 BROOKLEY RD # 510
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City | ROME
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State | NY
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Zip | 13441-3397
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Country | US
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Telephone | 315-334-7100
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 5639841
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 351943
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License Number State | NY
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