Provider Demographics
NPI:1144860651
Name:SMITH, DAVID COOPER (FNP-BC, PHN, CNL)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:COOPER
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-BC, PHN, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82879 KINGSBORO LN
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-9667
Mailing Address - Country:US
Mailing Address - Phone:415-341-7742
Mailing Address - Fax:
Practice Address - Street 1:81719 DR CARREON BLVD STE A
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5518
Practice Address - Country:US
Practice Address - Phone:760-340-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95032693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner