Provider Demographics
NPI:1144933649
Name:SMITH, LARRY JAMES
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44617 S AIRPORT RD STE C&D
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0311
Mailing Address - Country:US
Mailing Address - Phone:985-348-5059
Mailing Address - Fax:
Practice Address - Street 1:44617 S AIRPORT RD STE C&D
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0311
Practice Address - Country:US
Practice Address - Phone:985-348-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA068563163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health