Provider Demographics
NPI:1568142040
Name:SMITH, NICOLE DANIELLE (MSN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MAPLE AVE STE 6A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-8136
Mailing Address - Country:US
Mailing Address - Phone:214-266-0130
Mailing Address - Fax:214-266-0144
Practice Address - Street 1:5151 MAPLE AVE STE 6A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-8136
Practice Address - Country:US
Practice Address - Phone:214-266-0130
Practice Address - Fax:214-266-0144
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX876101163W00000X
TX1130548363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse