Healthcare Provider Details

I. General information

NPI: 1952734162
Provider Name (Legal Business Name): MELODY LEIGH SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6459 HIGHWAY 72
KILLEN AL
35645-8258
US

IV. Provider business mailing address

PO BOX 2587
MUSCLE SHOALS AL
35662-2587
US

V. Phone/Fax

Practice location:
  • Phone: 256-272-0275
  • Fax: 256-272-0277
Mailing address:
  • Phone: 256-383-4473
  • Fax: 256-381-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-057016
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-057016
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: