Provider Demographics
NPI:1407591316
Name:SMITH, MICHELLE NICOLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S NATIONAL AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5279
Mailing Address - Country:US
Mailing Address - Phone:417-269-8817
Mailing Address - Fax:417-269-8744
Practice Address - Street 1:3800 S NATIONAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5279
Practice Address - Country:US
Practice Address - Phone:417-269-8817
Practice Address - Fax:417-269-8744
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program