Healthcare Provider Details

I. General information

NPI: 1588617666
Provider Name (Legal Business Name): STEVEN MICHAEL SMITH CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 TAYLOR RD SUITE 310
MONTGOMERY AL
36117-3563
US

IV. Provider business mailing address

301 BROWN SPRINGS RD ATTN: PROVIDER ENROLLMENT
MONTGOMERY AL
36117-7005
US

V. Phone/Fax

Practice location:
  • Phone: 334-244-4322
  • Fax: 334-244-4321
Mailing address:
  • Phone: 334-273-4508
  • Fax: 334-273-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-040648
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: