Provider Demographics
NPI:1821342411
Name:SMITH, JO ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANNE
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 1:96 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-3057
Mailing Address - Country:US
Mailing Address - Phone:713-699-0500
Mailing Address - Fax:
Practice Address - Street 1:133 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3428
Practice Address - Country:US
Practice Address - Phone:361-552-4886
Practice Address - Fax:361-552-4896
Is Sole Proprietor?:No
Enumeration Date:2012-11-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX674982363LF0000X
TXAP122250363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily