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NPI Code Detail

MEDICARE: KRISTY K SMITH M.S.W.

MEDICARE: KRISTY K SMITH M.S.W.
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
1104100000XSocial WorkerC001338NC

Other Identifiers

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

General Provider Information

NPI Number : 1639282676
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTY K SMITH M.S.W.
Provider Business Mailing Address
First Line : 5605 ALTA VISTA CT
Second Line :
City : RALEIGH
State : NC
Zip : 27610-3261
Country : US
Telephone Number : 919-386-0402
Fax Number : 919-882-0931
Provider Business Practice Location Address
First Line : 110 PRESTON EXECUTIVE DR
Second Line : SUITE 106
City : CARY
State : NC
Zip : 27513-8447
Country : US
Telephone Number : 919-386-0402
Fax Number : 919-882-0931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 07/16/2015

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