Provider Demographics
NPI:1013206911
Name:SMITH, CECILY ROBIN (NP)
Entity Type:Individual
Prefix:
First Name:CECILY
Middle Name:ROBIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3453
Mailing Address - Country:US
Mailing Address - Phone:704-865-1700
Mailing Address - Fax:704-865-7948
Practice Address - Street 1:815 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3453
Practice Address - Country:US
Practice Address - Phone:704-865-1700
Practice Address - Fax:704-865-7948
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC160288363L00000X
CO990018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73884766Medicaid
CO73884766Medicaid
COP00956731Medicare PIN