Provider Demographics
NPI:1568014751
Name:SMITH, AMBERLY DAWN (CRNP)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:DAWN
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 1:153 ANA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1731
Mailing Address - Country:US
Mailing Address - Phone:256-236-7509
Mailing Address - Fax:256-648-5842
Practice Address - Street 1:153 ANA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1731
Practice Address - Country:US
Practice Address - Phone:256-367-0920
Practice Address - Fax:256-648-5842
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-143305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL238552Medicaid