Provider Demographics
NPI:1144228198
Name:SMITH, PATRICIA ANNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:VALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:146 SULLIVAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3450
Mailing Address - Country:US
Mailing Address - Phone:210-337-4233
Mailing Address - Fax:210-337-4799
Practice Address - Street 1:2828 GOLIAD RD
Practice Address - Street 2:SUITE #125
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3966
Practice Address - Country:US
Practice Address - Phone:210-337-4233
Practice Address - Fax:210-337-4210
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily