Healthcare Provider Details

I. General information

NPI: 1487677068
Provider Name (Legal Business Name): BRENDA LEA SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 MOFFETT RD
SEMMES AL
36575-5406
US

IV. Provider business mailing address

2031 SNOW RD N
SEMMES AL
36575-7629
US

V. Phone/Fax

Practice location:
  • Phone: 251-645-8946
  • Fax: 251-645-8976
Mailing address:
  • Phone: 251-645-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-062996
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-062996
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: