Provider Demographics
NPI:1689329195
Name:SMITH, JOEL DAVIS (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 E CRESTLINE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3656
Mailing Address - Country:US
Mailing Address - Phone:303-792-3242
Mailing Address - Fax:
Practice Address - Street 1:7400 E CRESTLINE CIR STE 100
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3656
Practice Address - Country:US
Practice Address - Phone:303-792-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily