MEDICARE: KIMBERLY A SMITH NP

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	APN.0995157	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RXN.0104832-NP	CO
3	363LF0000X	Family Nurse Practitioner	APN.0995157	CO
4	163W00000X	Registered Nurse	RN.1629567	CO

General Provider Information

NPI Number	:	1407492531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A SMITH NP

Provider Business Mailing Address
First Line	:	8261 BRIGANTINE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4422
Country	:	US
Telephone Number	:	719-751-6720
Fax Number	:	719-888-1817

Provider Business Practice Location Address
First Line	:	8261 BRIGANTINE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4422
Country	:	US
Telephone Number	:	719-751-6720
Fax Number	:	719-888-1817

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	03/11/2026

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