Provider Demographics
NPI:1164654646
Name:SMITH, AUDREY RACHAL (NP)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:RACHAL
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1800 BUCKNER ST
Mailing Address - Street 2:SUITE C-120
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4440
Mailing Address - Country:US
Mailing Address - Phone:318-227-8899
Mailing Address - Fax:318-213-2799
Practice Address - Street 1:1800 BUCKNER ST
Practice Address - Street 2:SUITE C-120
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-227-8899
Practice Address - Fax:318-213-2799
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN075508-AP05913363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner