Provider Demographics
NPI:1174718233
Name:SMITH, KRISTIN ANN (APN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S 320TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4691
Mailing Address - Country:US
Mailing Address - Phone:253-838-1520
Mailing Address - Fax:360-782-3540
Practice Address - Street 1:700 S 320TH ST STE B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4691
Practice Address - Country:US
Practice Address - Phone:253-838-1520
Practice Address - Fax:360-782-3540
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350023NP367A00000X
WAAP60616129367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYVAD000OtherUPI
WA2056840Medicaid