Provider Demographics
NPI:1588179949
Name:SMART, MICHAEL (NP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SMART
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1028
Mailing Address - Country:US
Mailing Address - Phone:307-660-7274
Mailing Address - Fax:
Practice Address - Street 1:606 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1028
Practice Address - Country:US
Practice Address - Phone:307-660-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH149509363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health