Provider Demographics
NPI:1326756297
Name:SMITH, MARKEETA ANTOINETTE
Entity Type:Individual
Prefix:MISS
First Name:MARKEETA
Middle Name:ANTOINETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARKEETA
Other - Middle Name:ANTOINETTE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1290 E ARLINGTON BLVD STE 143
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7067
Mailing Address - Country:US
Mailing Address - Phone:252-717-8014
Mailing Address - Fax:
Practice Address - Street 1:1290 E ARLINGTON BLVD STE 143
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7067
Practice Address - Country:US
Practice Address - Phone:252-717-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC342000000X
347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company
No347C00000XTransportation ServicesPrivate Vehicle