Provider Demographics
NPI:1205570173
Name:SMITH, RONNIE SCOTT (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8410
Mailing Address - Country:US
Mailing Address - Phone:832-373-7719
Mailing Address - Fax:
Practice Address - Street 1:804 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8410
Practice Address - Country:US
Practice Address - Phone:832-373-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1074473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health