Provider Demographics
NPI:1144365206
Name:SMITH, KRISTEN JANE (MA, ATC, EMT(B))
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, ATC, EMT(B)
Other - Prefix:
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Other - Middle Name:
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Other - Suffix:
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Mailing Address - Street 1:5230 SHANE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7130
Mailing Address - Country:US
Mailing Address - Phone:268-372-0180
Mailing Address - Fax:
Practice Address - Street 1:1200 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3268
Practice Address - Country:US
Practice Address - Phone:269-337-7090
Practice Address - Fax:269-337-7401
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3203002866146N00000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer