MEDICARE: KATHRYN L. SMITH MA, LPA

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	103T00000X	Psychologist	1039	NC

General Provider Information

NPI Number	:	1447568878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN L. SMITH MA, LPA

Provider Business Mailing Address
First Line	:	209 N 35TH ST STE B-2
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3183
Country	:	US
Telephone Number	:	252-269-2160
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 N 35TH ST STE B-2
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3183
Country	:	US
Telephone Number	:	252-269-2160
Fax Number	:

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

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	06/25/2014

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