Provider Demographics
NPI:1740379395
Name:SMITH, BETTY L (FNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6251 PHILLIPPI RD
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:NC
Mailing Address - Zip Code:27283-9242
Mailing Address - Country:US
Mailing Address - Phone:336-685-0024
Mailing Address - Fax:336-685-0024
Practice Address - Street 1:6251 PHILLIPPI RD
Practice Address - Street 2:
Practice Address - City:JULIAN
Practice Address - State:NC
Practice Address - Zip Code:27283-9242
Practice Address - Country:US
Practice Address - Phone:336-685-0024
Practice Address - Fax:336-685-0024
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201910363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner