Doctor Name: | SHAUNDE JERMAINE SMITH |
NPI Number: | 1124268529 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 656857 |
Business Practice Address: | 1185 N 11th St Silsbee, TX - 776563619 |
Business Phone Number: | 4092762067 |
Business Fax Number: | |
Mailing Address: | 1017 Fm 105, EVADALE |
State: | TX |
Postal Code: | 77615 |
Phone Number: | 4092762067 |
Fax Number: | 4092762059 |
NPI Enumeration Date: | 02/24/2009 |
NPI Last Update Date: | 03/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 656857 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |