Provider Demographics
NPI:1174726392
Name:SMITH, KIRA L (LNM)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 1019
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-246-4029
Mailing Address - Fax:860-240-7072
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 1019
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-246-4029
Practice Address - Fax:860-240-7072
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000309367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000309OtherLNM MEDICAL LICENSE