Provider Demographics
NPI:1215362215
Name:SMITH, MARY BETH (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E MARSHALL AVE
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5573
Mailing Address - Country:US
Mailing Address - Phone:903-315-2700
Mailing Address - Fax:903-236-2575
Practice Address - Street 1:705 E MARSHALL AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5573
Practice Address - Country:US
Practice Address - Phone:903-315-2700
Practice Address - Fax:903-236-2575
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXCNM 1683367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife