Provider Demographics
NPI:1437190048
Name:SMITH, ANNE MARIA (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3988
Mailing Address - Country:US
Mailing Address - Phone:252-449-7474
Mailing Address - Fax:
Practice Address - Street 1:5112 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3988
Practice Address - Country:US
Practice Address - Phone:252-449-7474
Practice Address - Fax:252-449-7475
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNP201598363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003732Medicaid
NCP00311106OtherMEDICARE RAILROAD
P15681Medicare UPIN
NC7003732Medicaid