Healthcare Provider Details

I. General information

NPI: 1659287829
Provider Name (Legal Business Name): MAGEN SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SLAUGHTER RD
MADISON AL
35758-8610
US

IV. Provider business mailing address

1650 SLAUGHTER RD
MADISON AL
35758-8610
US

V. Phone/Fax

Practice location:
  • Phone: 256-325-3646
  • Fax:
Mailing address:
  • Phone: 256-325-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-139328
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: