Provider Demographics
NPI:1316629579
Name:SMITH, DAKOTA DANYELL
Entity type:Individual
Prefix:MS
First Name:DAKOTA
Middle Name:DANYELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15127 BLUE THISTLE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2158
Mailing Address - Country:US
Mailing Address - Phone:832-384-3225
Mailing Address - Fax:
Practice Address - Street 1:15127 BLUE THISTLE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2158
Practice Address - Country:US
Practice Address - Phone:832-384-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator