Provider Demographics
NPI:1619254463
Name:SMITH, ALLEN CHARLES III (CRNP)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:CHARLES
Last Name:SMITH
Suffix:III
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 CHRISTIAN SPRING RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9490
Mailing Address - Country:US
Mailing Address - Phone:484-347-9954
Mailing Address - Fax:
Practice Address - Street 1:1565 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-4744
Practice Address - Country:US
Practice Address - Phone:610-867-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010690363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care