Provider Demographics
NPI:1508104886
Name:SMITH, EMY MCCLENDON (ACNP-AG)
Entity Type:Individual
Prefix:
First Name:EMY
Middle Name:MCCLENDON
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACNP-AG
Other - Prefix:
Other - First Name:EMY
Other - Middle Name:LOUISE
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3410 WORTH ST STE 760
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2005
Mailing Address - Country:US
Mailing Address - Phone:469-800-7370
Mailing Address - Fax:469-800-7380
Practice Address - Street 1:3410 WORTH ST STE 760
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2005
Practice Address - Country:US
Practice Address - Phone:469-800-7370
Practice Address - Fax:469-800-7380
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY644302163W00000X
TX852068163W00000X
NYF430714363LA2100X
TXAP125614363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse