Provider Demographics
NPI:1417949801
Name:SMITH, PATRICK N (RN, FNP)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:N
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5930
Mailing Address - Country:US
Mailing Address - Phone:903-831-6848
Mailing Address - Fax:903-223-7089
Practice Address - Street 1:5212 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75501-5930
Practice Address - Country:US
Practice Address - Phone:903-831-6848
Practice Address - Fax:903-223-7089
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q38235Medicare UPIN