Basic Information
| Provider Information | |||||||||
| NPI: | 1174718233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 S 320TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980034691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538381520 | ||||||||
| FaxNumber: | 3607823540 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 S 320TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980034691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538381520 | ||||||||
| FaxNumber: | 3607823540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 200350023NP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | AP60616129 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | VAD000 | 01 | KY | UPI | OTHER | 2056840 | 05 | WA | MEDICAID |