Provider Demographics
NPI:1174419733
Name:SMITH, JAVASHIA NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:JAVASHIA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 SPUR RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2252
Mailing Address - Country:US
Mailing Address - Phone:337-256-9675
Mailing Address - Fax:
Practice Address - Street 1:7002 SPUR RANCH RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2252
Practice Address - Country:US
Practice Address - Phone:432-664-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF06251257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily