Provider Demographics
NPI:1235729724
Name:SMITH, SAMONE (CNA)
Entity Type:Individual
Prefix:
First Name:SAMONE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 ANDERWOOD ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4215
Mailing Address - Country:US
Mailing Address - Phone:512-783-2188
Mailing Address - Fax:
Practice Address - Street 1:3207 ANDERWOOD ARBOR LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4215
Practice Address - Country:US
Practice Address - Phone:512-783-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 253Z00000X
TXNA0010358679376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide