Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NJ00498600 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00498600 | NJ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00498600 | NJ |
NPI | 1083034946 |
---|---|
Provider Name | Kaitlyn Smith |
First Address | Hillsborough, NJ 08844-1528 |
Second Address | Randolph, NJ 07869-1925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2014 |
Last Update Date | 25/03/2015 |