Provider Demographics
NPI:1427288406
Name:SMITH-CLARK, ALEAH R (LVN)
Entity type:Individual
Prefix:
First Name:ALEAH
Middle Name:R
Last Name:SMITH-CLARK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ALEAH
Other - Middle Name:RON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2911
Mailing Address - Country:US
Mailing Address - Phone:512-483-5800
Mailing Address - Fax:512-483-5827
Practice Address - Street 1:5225 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1820
Practice Address - Country:US
Practice Address - Phone:512-483-5800
Practice Address - Fax:512-483-5827
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171244164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse