Provider Demographics
NPI:1326583360
Name:SMITH, BETTY ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:ANN
Other - Last Name:FAULK SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:905 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLLS
Mailing Address - State:GA
Mailing Address - Zip Code:31554-4016
Mailing Address - Country:US
Mailing Address - Phone:912-921-3772
Mailing Address - Fax:
Practice Address - Street 1:201 N BARTOW ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-1435
Practice Address - Country:US
Practice Address - Phone:229-686-2774
Practice Address - Fax:229-543-1348
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily