Provider Demographics
NPI:1407844129
Name:SMITH, JOAN K (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-0498
Mailing Address - Country:US
Mailing Address - Phone:712-623-7280
Mailing Address - Fax:712-623-7279
Practice Address - Street 1:1400 SENATE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1271
Practice Address - Country:US
Practice Address - Phone:712-623-7280
Practice Address - Fax:712-623-7279
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA103947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421102673OtherFEDERAL TAX ID NUMBER