Provider Demographics
NPI:1306947791
Name:SMITH, HEATHER NICOSIA (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOSIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17191 ST LUKES WAY
Mailing Address - Street 2:200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8042
Mailing Address - Country:US
Mailing Address - Phone:936-273-2016
Mailing Address - Fax:936-273-2018
Practice Address - Street 1:17191 ST LUKES WAY
Practice Address - Street 2:200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8042
Practice Address - Country:US
Practice Address - Phone:936-273-2016
Practice Address - Fax:936-273-2018
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX708458163WP0200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX708458OtherSTATES LICENSE NUMBER