Provider Demographics
NPI:1124268529
Name:SMITH, SHAUNDE JERMAINE (NP)
Entity type:Individual
Prefix:
First Name:SHAUNDE
Middle Name:JERMAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 HIGHWAY 327 E
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-5005
Mailing Address - Country:US
Mailing Address - Phone:409-385-0556
Mailing Address - Fax:409-385-4676
Practice Address - Street 1:711 HIGHWAY 327 E
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-5005
Practice Address - Country:US
Practice Address - Phone:409-385-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656857363LA2200X, 363LF0000X
TXAP117554363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health