Provider Demographics
NPI:1588731749
Name:SMITH, MILDRED MARIE (RN,MS, MN, PNP)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN,MS, MN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CHEETAH TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5621
Mailing Address - Country:US
Mailing Address - Phone:254-698-4163
Mailing Address - Fax:
Practice Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER
Practice Address - Street 2:36000 DARNALL LOOP
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-286-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640264363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics