Provider Demographics
NPI:1245274380
Name:SMITH, TERRY (CNM)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 MEDICAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:505-434-2229
Mailing Address - Fax:505-439-5705
Practice Address - Street 1:2559 MEDICAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:505-434-2229
Practice Address - Fax:505-439-5705
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM496367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR49850OtherNM LICENSE
NM1343082Medicare ID - Type Unspecified