Provider Demographics
NPI:1295816536
Name:SMITH, CAROLYN H (RNP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:H
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3529 HIRONDELLE LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2221
Mailing Address - Country:US
Mailing Address - Phone:314-814-8585
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:1717 BIDDLE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-3454
Practice Address - Country:US
Practice Address - Phone:314-814-8585
Practice Address - Fax:314-814-8542
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO082848363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4235666413Medicaid
MO4235666413Medicaid