Provider Demographics
NPI:1982147641
Name:SMITH, NICOLE DEBORAH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DEBORAH
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:SLACK-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:888 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3514
Practice Address - Country:US
Practice Address - Phone:509-942-2648
Practice Address - Fax:509-942-2812
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60202435163W00000X
WAAP60721271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse