Provider Demographics
NPI:1013931559
Name:SMITH, LANITA ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LANITA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LANITA
Other - Middle Name:ANN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1005 JONES ST
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5861
Mailing Address - Country:US
Mailing Address - Phone:936-632-9983
Mailing Address - Fax:
Practice Address - Street 1:2206 N JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-1776
Practice Address - Country:US
Practice Address - Phone:936-671-4300
Practice Address - Fax:936-671-4321
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX573232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO85N9254Medicaid
TXPO85N9254Medicaid