Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1709 | AZ |
Y | 213ES0000X | Sports Medicine | 1709 | AZ |
NPI | 1013683937 |
---|---|
Provider Name | Kristen Anne Smith |
First Address | Reno, NV 89523-2535 |
Second Address | Reno, NV 89557-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2021 |
Last Update Date | 19/08/2021 |