Provider Demographics
NPI:1043626757
Name:SMART, BETTY RICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:RICHELLE
Last Name:SMART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RICHELLE
Other - Middle Name:
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-370-7851
Mailing Address - Fax:985-370-7409
Practice Address - Street 1:1900 S MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5742
Practice Address - Country:US
Practice Address - Phone:985-230-5726
Practice Address - Fax:985-230-5691
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07991363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner