MEDICARE: MS. KATHLEEN ANN SMERKO MS, PSY NP BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN071540	AZ

General Provider Information

NPI Number	:	1366453029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANN SMERKO MS, PSY NP BC

Provider Business Mailing Address
First Line	:	1110 E MISSOURI AVE
Second Line	:	STE 640
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2735
Country	:	US
Telephone Number	:	602-235-9505
Fax Number	:	602-235-9506

Provider Business Practice Location Address
First Line	:	1110 E MISSOURI AVE
Second Line	:	STE 640
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2735
Country	:	US
Telephone Number	:	602-235-9505
Fax Number	:	602-235-9506

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/17/2016

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