Provider Demographics
NPI:1174662290
Name:SMITH, DEMETRICE HOSKINS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEMETRICE
Middle Name:HOSKINS
Last Name:SMITH
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 1:33 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6461
Mailing Address - Country:US
Mailing Address - Phone:985-652-4040
Mailing Address - Fax:985-652-4009
Practice Address - Street 1:33 OXFORD DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6461
Practice Address - Country:US
Practice Address - Phone:985-652-4040
Practice Address - Fax:985-652-4009
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05001363LF0000X
TX747107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily