MEDICARE: KRISTY SMITH

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	APN000926	NV

General Provider Information

NPI Number	:	1881744886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY SMITH

Provider Business Mailing Address
First Line	:	9101 ALTA DR UNIT 1205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8541
Country	:	US
Telephone Number	:	702-325-1577
Fax Number	:	702-380-3220

Provider Business Practice Location Address
First Line	:	5440 W SAHARA AVE STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0361
Country	:	US
Telephone Number	:	702-380-8200
Fax Number	:	702-380-3220

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	10/07/2020

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Directions to “ KRISTY SMITH ” Practice Location

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