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General NPI Number Information
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NPI Number | 1578081725
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Entity Type | Individual
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Provider Name | KRISTA NICHOLE SMITH
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Gender | Female
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 1451 LUCAS RD
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City | MANSFIELD
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State | OH
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Zip | 44903-8682
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Country | US
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Telephone | 419-589-5511
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Fax | 419-589-5054
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Provider Business Mailing Address
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Address Line | PO BOX 214
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City | BUTLER
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State | OH
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Zip | 44822-0214
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Country | US
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Telephone | 419-566-5974
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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 | RN391975
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License Number State | OH
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