Provider Demographics
NPI:1700360286
Name:SMITH, ALLYSON (NP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 STILLWATER CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-8038
Mailing Address - Country:US
Mailing Address - Phone:469-993-6535
Mailing Address - Fax:
Practice Address - Street 1:5232 COLLEYVILLE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7827
Practice Address - Country:US
Practice Address - Phone:817-912-9920
Practice Address - Fax:817-498-0635
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily