Provider Demographics
NPI:1316647753
Name:SMITH, TIERRA Q (FNP-BC)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:Q
Last Name:SMITH
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N 8TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2989
Mailing Address - Country:US
Mailing Address - Phone:618-274-9105
Mailing Address - Fax:618-274-9101
Practice Address - Street 1:100 N 8TH ST STE 120
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2989
Practice Address - Country:US
Practice Address - Phone:618-274-9105
Practice Address - Fax:618-274-9101
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023007983363LF0000X
IL209027198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily