Provider Demographics
NPI:1457978694
Name:SMITH, TONI LYNN (ACAGNP - BC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACAGNP - BC
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACAGNP - BC
Mailing Address - Street 1:8390 LYNDON B JOHNSON FWY STE 1000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1288
Mailing Address - Country:US
Mailing Address - Phone:214-750-9977
Mailing Address - Fax:
Practice Address - Street 1:8390 LYNDON B JOHNSON FWY STE 1000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1288
Practice Address - Country:US
Practice Address - Phone:214-750-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001844363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care