Healthcare Provider Details

I. General information

NPI: 1790534030
Provider Name (Legal Business Name): SHEYENNE WRIGHT SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ROSS CLARK CIR STE 100
DOTHAN AL
36301-3023
US

IV. Provider business mailing address

1970 COUNTY ROAD 712
ENTERPRISE AL
36330-6490
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-1148
  • Fax:
Mailing address:
  • Phone: 334-790-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-173652
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-173652
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: