Provider Demographics
NPI:1487677068
Name:SMITH, BRENDA LEA (CRNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 SNOW RD N
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-7629
Mailing Address - Country:US
Mailing Address - Phone:251-645-0927
Mailing Address - Fax:
Practice Address - Street 1:8010 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5406
Practice Address - Country:US
Practice Address - Phone:251-645-8946
Practice Address - Fax:251-645-8976
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-062996363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily