Provider Demographics
NPI:1164419594
Name:SMITHERS, BONNIE BOYD (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:BOYD
Last Name:SMITHERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HARMONY LOOP
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-7306
Mailing Address - Country:US
Mailing Address - Phone:903-421-3454
Mailing Address - Fax:
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-892-6245
Practice Address - Fax:903-891-4295
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR102295163W00000X
TX455238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD985L599EMedicare ID - Type UnspecifiedMEDICARE PROVIDER #