Katherine Ellen Smith, PNP-C

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

383131 Issued in NY

Practice address

736 Irving Ave # 9100
Syracuse, NY 13210-1687

Phone

(315) 470-7379

NPI assigned

Jun 11, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ksmith@josevargas.medentdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Buckley Road Pediatrics, PLLC

  • Pediatrics Physician
  • North Syracuse, NY
  • NPI 1669535548
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1023633427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ROCKFORD DR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132241828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 IRVING AVE # 9100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101687",
            "telephone_number": "315-470-7379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATHERINE",
        "middle_name": "ELLEN",
        "credential": "PNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "383131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garrett E Smith, MD
• Hailey Ann Marie Smith
• Jessica Lynne Smith
• Joseph L Smith, LCSW PHD
• Katelyn Smith
• Katherine Mackey Smith, MS SPED
• Kathy Smith
• Kayson Smith
• Kelsey Kay Smith, CRPA
• Kevin James Smith

• Pediatric Nurse Practitioner in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.