Provider Demographics
NPI:1407196264
Name:SMITH, DANNAH M (FNP)
Entity type:Individual
Prefix:
First Name:DANNAH
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3027
Mailing Address - Country:US
Mailing Address - Phone:903-280-7919
Mailing Address - Fax:903-306-0055
Practice Address - Street 1:4506 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3027
Practice Address - Country:US
Practice Address - Phone:903-280-7919
Practice Address - Fax:903-306-0055
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX701116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX317723001Medicaid