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General NPI Number Information
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NPI Number | 1558740548
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Entity Type | Organization
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Legal Business Name | KATHLEEN A SMERKO PMHNP-BC LLC
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 1121 E MISSOURI AVE STE 104
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City | PHOENIX
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State | AZ
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Zip | 85014-2723
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Country | US
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Telephone | 602-235-9506
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Fax | 602-235-9506
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Provider Business Mailing Address
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Address Line | 1121 E MISSOURI AVE STE 104
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City | PHOENIX
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State | AZ
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Zip | 85014-2723
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Country | US
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Telephone | 602-235-9506
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Fax | 602-235-9506
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | KATHLEEN ANN SMERKO
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Credential | MS., PSY NP., BC.
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Telephone | 602-235-9505
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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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