Provider Demographics
NPI:1740340017
Name:SMITH, LAURA H (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 CARMICHAEL RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2801
Mailing Address - Country:US
Mailing Address - Phone:334-281-6363
Mailing Address - Fax:
Practice Address - Street 1:2460 CURTIS ELLIS DR
Practice Address - Street 2:ATT: OPERATING ROOM
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2237
Practice Address - Country:US
Practice Address - Phone:334-281-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-041326363LF0000X
NC190818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC14940281OtherMEDICARE NC
ALBO000077004Medicaid
AL2809812OtherRAILROAD MEDICARE
NC14940281OtherMEDICARE PTAN
NC7000969Medicaid
ALBOO51506240Medicaid
NC14940281OtherMEDICARE PTAN
ALS61632Medicare UPIN
ALBOO51506240Medicaid