Provider Demographics
NPI:1427556679
Name:SMITH, BOBBY JOE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:JOE
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11491 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0136
Mailing Address - Country:US
Mailing Address - Phone:256-894-6700
Mailing Address - Fax:
Practice Address - Street 1:11491 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0136
Practice Address - Country:US
Practice Address - Phone:256-894-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-140923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily