Provider Demographics
NPI:1578680815
Name:SMITH, SHIRLEY ANN (ADVANCED PRACTICE NU)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NU
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:LEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADVANCED PRACTICE NU
Mailing Address - Street 1:501 N. STONE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-1134
Mailing Address - Country:US
Mailing Address - Phone:979-567-8500
Mailing Address - Fax:979-335-9415
Practice Address - Street 1:501 NORTH STONE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1134
Practice Address - Country:US
Practice Address - Phone:979-567-8500
Practice Address - Fax:979-335-9415
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX517771363LF0000X, 363LP0808X
TX1578680815363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159748601Medicaid
TX8A8625Medicaid
TXP92632Medicare UPIN