Provider Demographics
NPI:1669011300
Name:SMITH, ALEXA (NP)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E BROAD ST STE 304
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6412
Mailing Address - Country:US
Mailing Address - Phone:817-477-5500
Mailing Address - Fax:817-453-5503
Practice Address - Street 1:2800 E BROAD ST #304
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-477-5500
Practice Address - Fax:817-453-5503
Is Sole Proprietor?:No
Enumeration Date:2019-12-28
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP143645OtherTEXAS BON