Provider Demographics
NPI:1508456567
Name:SMITH, DAVID ALLEN (ARNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2596 WITTY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-8830
Mailing Address - Country:US
Mailing Address - Phone:406-249-0876
Mailing Address - Fax:
Practice Address - Street 1:2425 US HIGHWAY 2 E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2309
Practice Address - Country:US
Practice Address - Phone:406-257-1680
Practice Address - Fax:406-257-3264
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-174664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty