Provider Demographics
NPI:1568072817
Name:SMITH, CARISSA SHANAE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:SHANAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 KATHERINE TRL
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9374
Mailing Address - Country:US
Mailing Address - Phone:252-885-3390
Mailing Address - Fax:
Practice Address - Street 1:3208 SUNSET AVE STE C
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3590
Practice Address - Country:US
Practice Address - Phone:252-266-3164
Practice Address - Fax:919-578-1516
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5013384OtherNP LICENSE
NC5013384OtherNP LICENSE