Provider Demographics
NPI:1861255069
Name:SMITH, LANITRA TASHUN (NP)
Entity type:Individual
Prefix:MRS
First Name:LANITRA
Middle Name:TASHUN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 HALLIE HTS
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-6239
Mailing Address - Country:US
Mailing Address - Phone:409-599-3201
Mailing Address - Fax:
Practice Address - Street 1:6608 HALLIE HTS
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-6239
Practice Address - Country:US
Practice Address - Phone:409-599-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1144468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily