Provider Demographics
NPI:1417672320
Name:SMITH, NTEESHA SHERLENE
Entity Type:Individual
Prefix:
First Name:NTEESHA
Middle Name:SHERLENE
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 1:6518 TALBOT PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-2908
Mailing Address - Country:US
Mailing Address - Phone:469-449-7858
Mailing Address - Fax:
Practice Address - Street 1:6518 TALBOT PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-2908
Practice Address - Country:US
Practice Address - Phone:469-449-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide