Individual provider Active NPI

Kathryn A. Smith, FNP

  • Family Nurse Practitioner
  • Metter, GA
National Provider Identifier
1356458954
Registry record updated Feb 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN081837 Issued in GA
Practice address
154 S Leroy St
Metter, GA 30439-4631
Phone
(912) 685-4040
Fax
(912) 685-4041
NPI assigned
Aug 23, 2006
Last updated
Feb 27, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN081837 GA Primary

Addresses

Primary practice location

154 S Leroy St
Metter, GA 30439-4631

Mailing address

215 N Coleman St
Swainsboro, GA 30401-3530
Phone (478) 237-6262

Other identifiers 1

IdentifierTypeStateIssuer
000454088DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050310000150 GA Practitioner - Nurse Practitioner 6305890559

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
East Georgia Healthcare Center, Inc. Current Accepting new patients

Locations

117 Memorial Dr
Reidsville, GA 30453
Phone (912) 557-3300

215 N Coleman St
Swainsboro, GA 30401
Phone (478) 237-2638

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBFFAA

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1356458954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N COLEMAN ST",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013530",
            "telephone_number": "478-237-6262",
            "fax_number": "478-237-9138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 S LEROY ST",
            "city": "METTER",
            "state": "GA",
            "postal_code": "304394631",
            "telephone_number": "912-685-4040",
            "fax_number": "912-685-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATHRYN",
        "middle_name": "A.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN081837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000454088D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Metter, GA

Sources for this page

Verify at the official NPI Registry.