Provider Demographics
NPI:1013982693
Name:SMITH, SAMMI R (MD)
Entity Type:Individual
Prefix:
First Name:SAMMI
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2449 HOSPITAL DR.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1914
Mailing Address - Country:US
Mailing Address - Phone:315-212-7902
Mailing Address - Fax:318-212-7905
Practice Address - Street 1:2727 HEARNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3931
Practice Address - Country:US
Practice Address - Phone:318-631-6400
Practice Address - Fax:318-631-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04110363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1138576Medicaid
P68321Medicare UPIN
LA4C315Medicare ID - Type Unspecified