Provider Demographics
NPI:1689608028
Name:SMITH, JOAN (NP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 S CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3203
Mailing Address - Country:US
Mailing Address - Phone:972-642-3910
Mailing Address - Fax:972-642-3740
Practice Address - Street 1:4203 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:972-642-3910
Practice Address - Fax:972-642-3740
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX251268363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse