Provider Demographics
NPI:1720433014
Name:SMITH, MEGAN ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9641 FERNCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:LA
Mailing Address - Zip Code:71007-8725
Mailing Address - Country:US
Mailing Address - Phone:318-294-5657
Mailing Address - Fax:
Practice Address - Street 1:9641 FERNCLIFF RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:LA
Practice Address - Zip Code:71007-8725
Practice Address - Country:US
Practice Address - Phone:318-294-5657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program