MEDICARE: MISS CURTRELL LATRICE SMITH FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP08306	LA

General Provider Information

NPI Number	:	1265803464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CURTRELL LATRICE SMITH FNP-C

Provider Business Mailing Address
First Line	:	4950 ESSEN LN STE 300
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3739
Country	:	US
Telephone Number	:	225-757-0343
Fax Number	:	225-757-8354

Provider Business Practice Location Address
First Line	:	4950 ESSEN LN STE 300
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3739
Country	:	US
Telephone Number	:	225-757-0343
Fax Number	:	225-757-8354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	02/07/2020

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