Provider Demographics
NPI:1760666085
Name:SMITH, SAUNDRA B (CFNP)
Entity Type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:SAUNDRA
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:950 N 14TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1101
Mailing Address - Country:US
Mailing Address - Phone:409-833-5858
Mailing Address - Fax:409-833-1155
Practice Address - Street 1:950 N 14TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1101
Practice Address - Country:US
Practice Address - Phone:409-833-5858
Practice Address - Fax:409-833-1155
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily