Individual
KATHRYN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1111 DELAFIELD STREET, SUITE 120, WAUKESHA, WI 53188-3407
(262) 544-4411
(262) 650-3856
Mailing address
1111 DELAFIELD STREET, SUITE 120, WAUKESHA, WI 53188-3407
(262) 544-4411
(262) 650-3856
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4044-23
WI
363A00000X
Physician Assistant
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071249
—
WI
05
—
1831619279
—
WI
Enumeration date
06/27/2017
Last updated
03/26/2025
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