Provider Demographics
NPI:1225368806
Name:SMITH, RACHEL
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 BAYOU CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-7036
Mailing Address - Country:US
Mailing Address - Phone:414-617-4074
Mailing Address - Fax:
Practice Address - Street 1:6437 BAYOU CROSSING DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-7036
Practice Address - Country:US
Practice Address - Phone:414-617-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN125439-AP05945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN125439-AP05945OtherADVANCE PRACTICE REGISTERED NURSE