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NPI Code Detail

MEDICARE: MR. QUINTIN CRAIG SMITH FNP-C

MEDICARE: MR. QUINTIN CRAIG 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
1363LF0000XFamily Nurse Practitioner237202LA

General Provider Information

NPI Number : 1629803630
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. QUINTIN CRAIG SMITH FNP-C
Provider Business Mailing Address
First Line : 3662 W OAK ST
Second Line :
City : JENA
State : LA
Zip : 71342-4474
Country : US
Telephone Number : 318-495-2273
Fax Number :
Provider Business Practice Location Address
First Line : 3662 W OAK ST
Second Line :
City : JENA
State : LA
Zip : 71342-4474
Country : US
Telephone Number : 318-495-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2024
Last Update Date : 09/09/2024

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