Provider Demographics
NPI:1205089877
Name:SMITH, ANDREA LYNN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 W. CAMPBELL RD, SUITE 400
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-498-4389
Mailing Address - Fax:972-238-0455
Practice Address - Street 1:399 W. CAMPBELL RD, SUITE 400
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-498-4389
Practice Address - Fax:972-238-0455
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX694424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily