Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP04110 | LA |
NPI | 1013982693 |
---|---|
Provider Name | Sammi R Smith |
First Address | Bossier City, LA 71111-1914 |
Second Address | Shreveport, LA 71103-3931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 14/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1138576 | (05) | LA |
P68321 | (02) |