Doctor Name: | KATELYN N SMITH |
NPI Number: | 1508228818 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 209014112 |
Business Practice Address: | 270 Maple Summit Rd Jerseyville, IL - 620522004 |
Business Phone Number: | 6184987108 |
Business Fax Number: | 6184987919 |
Mailing Address: | 101 N State St, Attn;credentialing JERSEYVILLE |
State: | IL |
Postal Code: | 620521754 |
Phone Number: | 6184987518 |
Fax Number: | 6184983052 |
NPI Enumeration Date: | 03/25/2016 |
NPI Last Update Date: | 03/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209014112 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |