Provider Demographics
NPI:1710217682
Name:BAGWELL SMITH, JENNIFER RENEE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENEE
Last Name:BAGWELL SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:YOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CUPPLES
Mailing Address - Street 1:301 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3608
Mailing Address - Country:US
Mailing Address - Phone:817-371-6241
Mailing Address - Fax:
Practice Address - Street 1:416 S HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1017
Practice Address - Country:US
Practice Address - Phone:682-478-8123
Practice Address - Fax:888-851-5356
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118728367500000X
TX692657163W00000X, 367500000X
TX083700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse