Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 1143114 | AL |
NPI | 1043618879 |
---|---|
Provider Name | Carolyn Adele Smith |
First Address | Birmingham, AL 35242-5036 |
Second Address | Birmingham, AL 35242-5036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2014 |
Last Update Date | 10/12/2014 |