Provider Demographics
NPI:1063829315
Name:SMITH, SHEA O (CNP)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:O
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 2ND AVE S
Mailing Address - Street 2:FACULTY OFFICE TOWER STE 1038
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35924
Mailing Address - Country:US
Mailing Address - Phone:205-934-9879
Mailing Address - Fax:205-934-6088
Practice Address - Street 1:1720 2ND AVE S
Practice Address - Street 2:FACULTY OFFICE TOWER STE 1038
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35924
Practice Address - Country:US
Practice Address - Phone:205-934-9879
Practice Address - Fax:205-934-6088
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129131363LF0000X
NM68479363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily