Provider Demographics
NPI:1902150626
Name:SMITH, WILLIAM J JR (NP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 MARKHAM CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-3524
Mailing Address - Country:US
Mailing Address - Phone:480-247-9195
Mailing Address - Fax:
Practice Address - Street 1:1308 MARKHAM CT
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77846
Practice Address - Country:US
Practice Address - Phone:480-247-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122661363L00000X
TX717283363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner