Provider Demographics
NPI:1407842644
Name:SMITH, DONALD B (NP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 BUCKNER ST
Mailing Address - Street 2:SUITE C120
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4440
Mailing Address - Country:US
Mailing Address - Phone:318-227-8899
Mailing Address - Fax:318-425-3793
Practice Address - Street 1:1800 BUCKNER ST
Practice Address - Street 2:SUITE C120
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-227-8899
Practice Address - Fax:318-425-3793
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAO04282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAQ04433Medicare UPIN
LA4C9287907Medicare ID - Type Unspecified