Healthcare Provider Details

I. General information

NPI: 1689054512
Provider Name (Legal Business Name): BETTIE L SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12738 AL HIGHWAY 20 NW
MADISON AL
35756-4595
US

IV. Provider business mailing address

12738 AL HIGHWAY 20 NW
MADISON AL
35756-4595
US

V. Phone/Fax

Practice location:
  • Phone: 256-970-2190
  • Fax: 256-269-0667
Mailing address:
  • Phone: 256-970-2190
  • Fax: 256-269-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-088693
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: