Provider Demographics
NPI:1588425326
Name:SMITH, NATHANIEL GARRETT (CRNP)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:GARRETT
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1206 INVERNESS COVE WAY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4261
Mailing Address - Country:US
Mailing Address - Phone:256-614-9365
Mailing Address - Fax:
Practice Address - Street 1:2660 10TH AVE S STE 528
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1625
Practice Address - Country:US
Practice Address - Phone:205-933-9258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-180176363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care