1568563120 NPI number — MRS. KRISTINA RUTH SMITH N.P.

Table of content: MRS. KRISTINA RUTH SMITH N.P. (NPI 1568563120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568563120 NPI number — MRS. KRISTINA RUTH SMITH N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
KRISTINA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIGSWORTH
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568563120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 SUTHERLAND AVE
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-525-4333
Provider Business Mailing Address Fax Number:
865-212-8879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 SUTHERLAND AVE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-525-4333
Provider Business Practice Location Address Fax Number:
865-212-8879
Provider Enumeration Date:
09/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APN12145 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TN0139 . This is a "JOHN DEERE HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3644896 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".