Provider Demographics
NPI:1033586235
Name:SMITH, BARBARA (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
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 1:9900 BREN RD E
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9664
Mailing Address - Country:US
Mailing Address - Phone:706-525-1018
Mailing Address - Fax:
Practice Address - Street 1:1638 GA HIGHWAY 27 E
Practice Address - Street 2:
Practice Address - City:LESLIE
Practice Address - State:GA
Practice Address - Zip Code:31764-2124
Practice Address - Country:US
Practice Address - Phone:229-449-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily