Provider Demographics
NPI:1083225940
Name:SMITH, RANASSA RENEE (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:RANASSA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HEATHER MARIE DR
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-9413
Mailing Address - Country:US
Mailing Address - Phone:318-308-6054
Mailing Address - Fax:
Practice Address - Street 1:2226 WORLEY DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3600
Practice Address - Country:US
Practice Address - Phone:318-561-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214883363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics