Provider Demographics
NPI:1700133865
Name:SMITH, DEBRA R (FNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:R
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 1:2405 EAGLE NARROWS CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-6658
Mailing Address - Country:US
Mailing Address - Phone:817-236-6669
Mailing Address - Fax:
Practice Address - Street 1:6000 COLLEYVILLE BLVD
Practice Address - Street 2:STE 150
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8022
Practice Address - Country:US
Practice Address - Phone:817-328-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily