Provider Demographics
NPI:1841830346
Name:SMITH, NAKEETA SHANEE (LMT)
Entity type:Individual
Prefix:MRS
First Name:NAKEETA
Middle Name:SHANEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7502 CAMPBELL RD.
Practice Address - Street 2:SUITE 24
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1704
Practice Address - Country:US
Practice Address - Phone:469-456-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT114453225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist