Provider Demographics
NPI:1831375567
Name:SMITH, STACEY ANN (RRT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 VISTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-7268
Mailing Address - Country:US
Mailing Address - Phone:928-533-0166
Mailing Address - Fax:206-202-0410
Practice Address - Street 1:783 VISTA DEL SOL
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-7268
Practice Address - Country:US
Practice Address - Phone:928-533-0166
Practice Address - Fax:206-202-0410
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL00610227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered