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General NPI Number Information
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NPI Number | 1992109755
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Entity Type | Individual
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Provider Name | KATHLEEN W. SMITH APN
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Gender | Female
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 900 MAIN STREET SUITE 280
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City | PEORIA
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State | IL
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Zip | 61636-4688
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Country | US
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Telephone | 309-643-6118
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Fax | 309-517-7476
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Provider Business Mailing Address
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Address Line | 10611 N SLEEPY HOLLOW RD
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City | PEORIA
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State | IL
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Zip | 61615-1121
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Country | US
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Telephone | 309-712-1363
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Fax | 309-517-7476
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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 | 209.012013
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 209012013
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License Number State | IL
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