MEDICARE: KIM K. SMITH N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024165080	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194723130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM K. SMITH N.P.

Provider Business Mailing Address
First Line	:	119 BOONE RIDGE DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-4998
Country	:	US
Telephone Number	:	423-282-1480
Fax Number	:	423-928-1353

Provider Business Practice Location Address
First Line	:	1 MEDICAL PARK BLVD
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7430
Country	:	US
Telephone Number	:	423-282-1480
Fax Number	:	423-928-1353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/14/2014

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