Provider Demographics
NPI:1538306162
Name:SMITH, COREY B (CRNA)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4519 N GARFIELD ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3415
Mailing Address - Country:US
Mailing Address - Phone:432-699-0225
Mailing Address - Fax:432-520-2723
Practice Address - Street 1:4519 N GARFIELD ST
Practice Address - Street 2:SUITE 15
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3415
Practice Address - Country:US
Practice Address - Phone:432-699-0225
Practice Address - Fax:432-520-2723
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2015-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP123239367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered