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General NPI Number Information
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NPI Number | 1366453029
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Entity Type | Individual
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Provider Name | KATHLEEN ANN SMERKO MS, PSY NP BC
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Gender | Female
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 1110 E MISSOURI AVE STE 640
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City | PHOENIX
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State | AZ
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Zip | 85014-2735
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Country | US
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Telephone | 602-235-9505
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Fax | 602-235-9506
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Provider Business Mailing Address
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Address Line | 1110 E MISSOURI AVE STE 640
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City | PHOENIX
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State | AZ
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Zip | 85014-2735
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Country | US
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Telephone | 602-235-9505
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Fax | 602-235-9506
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN071540
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License Number State | AZ
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