Provider Demographics
NPI:1144008780
Name:SMITH, STACIE N (FNP)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 AIRPORT FWY STE 525
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3254
Mailing Address - Country:US
Mailing Address - Phone:817-522-1530
Mailing Address - Fax:
Practice Address - Street 1:860 AIRPORT FWY STE 525
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3254
Practice Address - Country:US
Practice Address - Phone:817-522-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily