Provider Demographics
NPI:1629745955
Name:SMITH, MEGAN ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4367 STONE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1839
Mailing Address - Country:US
Mailing Address - Phone:205-999-6473
Mailing Address - Fax:
Practice Address - Street 1:1167 COUNTY ROAD 437
Practice Address - Street 2:
Practice Address - City:GOOD HOPE
Practice Address - State:AL
Practice Address - Zip Code:35055-0203
Practice Address - Country:US
Practice Address - Phone:256-735-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166344363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics