Provider Demographics
NPI:1801634381
Name:SMITH, ANTOINETTE HAYDEN (CCE, CPE)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:HAYDEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCE, CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CROSS TIMBERS RD STE 1130
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-8815
Mailing Address - Country:US
Mailing Address - Phone:469-993-4402
Mailing Address - Fax:
Practice Address - Street 1:1001 CROSS TIMBERS RD STE 1130
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-8815
Practice Address - Country:US
Practice Address - Phone:469-993-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1124974374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician