Provider Demographics
NPI:1265415319
Name:SMITH, CHERYL E (CRNA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 952270
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75395-0001
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:3280 JOE BATTLE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2622
Practice Address - Country:US
Practice Address - Phone:915-832-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50008367500000X
TX581155367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1265415319OtherBCBS
TX80722HOtherBC/BS
TX180689502Medicaid
TX180689503Medicaid
TX2330101Medicaid
TX89985UOtherBCBS
NM1265415319OtherBCBS
S71894Medicare UPIN
TX8F21003Medicare PIN