Provider Demographics
NPI:1205581196
Name:SMITH, KRISTIN (PMHNP, BC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PMHNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 MILLSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1793
Mailing Address - Country:US
Mailing Address - Phone:804-234-6932
Mailing Address - Fax:
Practice Address - Street 1:1 W WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2009
Practice Address - Country:US
Practice Address - Phone:804-592-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183703363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health