Provider Demographics
NPI:1972882744
Name:SMITH, CARL HENRY (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:HENRY
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E 32ND ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3072
Mailing Address - Country:US
Mailing Address - Phone:417-781-2046
Mailing Address - Fax:417-781-2086
Practice Address - Street 1:1901 E 32ND ST
Practice Address - Street 2:SUITE 20
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3072
Practice Address - Country:US
Practice Address - Phone:417-781-2046
Practice Address - Fax:417-781-2086
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020010807363LP0808X
MO2012028469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health