Healthcare Provider Details

I. General information

NPI: 1740743830
Provider Name (Legal Business Name): ABBEY SMITH MASK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 04/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SIVLEY RD SW
HUNTSVILLE AL
35801-4470
US

IV. Provider business mailing address

29685 OXFORD CIR
HARVEST AL
35749-7187
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-1000
  • Fax:
Mailing address:
  • Phone: 334-332-7317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-172788
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: