Provider Demographics
NPI:1003356437
Name:SMITH, CHARLOTTE STEVENS (NP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:STEVENS
Last Name:SMITH
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-7724
Mailing Address - Country:US
Mailing Address - Phone:337-263-4980
Mailing Address - Fax:
Practice Address - Street 1:2830 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1809
Practice Address - Country:US
Practice Address - Phone:409-236-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ316334363LN0005X
LAAP05179363LN0005X
TXAP134933363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care