Provider Demographics
NPI:1982250064
Name:SMITH-CORLETTE, MARCIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:MARCIE
Middle Name:
Last Name:SMITH-CORLETTE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:
Other - Last Name:SMITH-CORLETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:12221 MERIT DR STE 450
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2294
Mailing Address - Country:US
Mailing Address - Phone:972-770-1032
Mailing Address - Fax:469-484-2126
Practice Address - Street 1:12221 MERIT DR STE 450
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2294
Practice Address - Country:US
Practice Address - Phone:972-770-1032
Practice Address - Fax:469-484-2126
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141979363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health