Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 243562 | TX |
NPI | 1003101718 |
---|---|
Provider Name | Leslie P Smith |
First Address | Waco, TX 76707-2261 |
Second Address | Waco, TX 76706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 30/04/2013 |