Provider Demographics
NPI:1558868695
Name:SMITH, AMY MARIE (APRN, ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2127
Mailing Address - Country:US
Mailing Address - Phone:210-363-2150
Mailing Address - Fax:
Practice Address - Street 1:2827 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4813
Practice Address - Country:US
Practice Address - Phone:817-657-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137206363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology