Provider Demographics
NPI:1184941759
Name:SMITH, JACQUELINE D (RN, MS, FNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, MS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5184 TEX OAK AVE
Mailing Address - Street 2:ANDERSON UROLOGY 4TH FLOOR
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7822
Mailing Address - Country:US
Mailing Address - Phone:214-590-6310
Mailing Address - Fax:
Practice Address - Street 1:5184 TEX OAK AVE
Practice Address - Street 2:ANDERSON UROLOGY 4TH FLOOR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7822
Practice Address - Country:US
Practice Address - Phone:214-590-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily