Kristin D Smith, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

2873 Issued in WI

Practice address

9200 W Wisconsin Ave
Neuropsychology
Milwaukee, WI 53226-3522

Phone

(414) 805-5660

Fax

(414) 259-9012

NPI assigned

Jun 21, 2010

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

Other identifiers 1

Other names 1

• Kristin D Phillips Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1376864710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "NEUROPSYCHOLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-5660",
            "fax_number": "414-259-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "NEUROPSYCHOLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-5660",
            "fax_number": "414-259-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KRISTIN",
        "middle_name": "D",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-21",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "2873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376864710",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "PHILLIPS",
            "middle_name": "D",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Johnelle Sharnise Smith
• Judson Charles Smith
• Karly Smith, LPN
• Kelly F Smith, DO
• Kinaya Smith, MD
• Kristin Lyn Smith, PHARM D
• Kyle David Smith, D.D.S.
• La Monte Smith, MSW
• Latoya M Smith
• Laura D Smith

• Clinical Neuropsychologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Neuropsychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.