Provider Demographics
NPI:1255848271
Name:SMOTHERS, TANISHA (RN)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 W LOUISIANA STATE DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2403
Mailing Address - Country:US
Mailing Address - Phone:504-452-9338
Mailing Address - Fax:
Practice Address - Street 1:300 CLAY ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7606
Practice Address - Country:US
Practice Address - Phone:504-452-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231610363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$Medicaid
$$$$$$$$$OtherPRIVATE INSURANCE