Provider Demographics
NPI:1194201251
Name:SMITH, STEPHANIE N (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 MAYFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-4224
Mailing Address - Country:US
Mailing Address - Phone:361-205-9557
Mailing Address - Fax:
Practice Address - Street 1:613 ELIZABETH ST STE 704
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2220
Practice Address - Country:US
Practice Address - Phone:361-885-0010
Practice Address - Fax:361-885-0001
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily