Provider Demographics
NPI:1699503243
Name:SMITH, STEPHANIE KRISTIN (MSN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KRISTIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KRISTIN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1605 BLUE QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6113
Mailing Address - Country:US
Mailing Address - Phone:619-757-8937
Mailing Address - Fax:
Practice Address - Street 1:3201 UNIVERSITY DR E STE 240
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:758-788-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM80107363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health