Provider Demographics
NPI:1518784073
Name:SMITH, KAYLEIGH (CRNP)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LAKEFRONT DR
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-9609
Mailing Address - Country:US
Mailing Address - Phone:814-659-6866
Mailing Address - Fax:
Practice Address - Street 1:800 HOWARD AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4728
Practice Address - Country:US
Practice Address - Phone:814-889-2708
Practice Address - Fax:814-946-3352
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily