Provider Demographics
NPI:1598579757
Name:SMITH, BEDIE (DNP, APRN-AGCNS-BC)
Entity type:Individual
Prefix:DR
First Name:BEDIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, APRN-AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 15TH AVE E
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2319
Mailing Address - Country:US
Mailing Address - Phone:763-331-2901
Mailing Address - Fax:
Practice Address - Street 1:14551 COUNTY ROAD 11 STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4799
Practice Address - Country:US
Practice Address - Phone:952-841-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN665364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health