Provider Demographics
NPI:1922402056
Name:SMITH, LORRIE (ANP)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-2048
Mailing Address - Country:US
Mailing Address - Phone:254-640-8345
Mailing Address - Fax:855-226-8732
Practice Address - Street 1:605 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-2048
Practice Address - Country:US
Practice Address - Phone:254-447-0243
Practice Address - Fax:855-226-8732
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126452363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health