Provider Demographics
NPI:1083167522
Name:SMITH, GINGER L (APRN NP-C)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 TEACO RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3236
Mailing Address - Country:US
Mailing Address - Phone:573-888-0001
Mailing Address - Fax:573-888-0006
Practice Address - Street 1:211 TEACO RD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3236
Practice Address - Country:US
Practice Address - Phone:573-888-0001
Practice Address - Fax:573-888-0006
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner