Provider Demographics
NPI:1457093304
Name:SMITH, MICHAEL T JR (LVN/LPN BSNC P-ANP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:LVN/LPN BSNC P-ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 ALMEDA RD UNIT 300171
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-1059
Mailing Address - Country:US
Mailing Address - Phone:832-788-7624
Mailing Address - Fax:
Practice Address - Street 1:13003 SHALLOW FALLS LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-6525
Practice Address - Country:US
Practice Address - Phone:832-788-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342112163W00000X, 164W00000X
TX22630966163W00000X
TXA030599261QC0050X, 390200000X
TXA35992282N00000X, 390200000X
390200000X
TXL342112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program