Healthcare Provider Details

I. General information

NPI: 1881516508
Provider Name (Legal Business Name): DAVID ALAN SMITH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 N CLANTON ST
BUCKEYE AZ
85396-7709
US

IV. Provider business mailing address

3252 N CLANTON ST
BUCKEYE AZ
85396-7709
US

V. Phone/Fax

Practice location:
  • Phone: 864-918-9632
  • Fax:
Mailing address:
  • Phone: 864-918-9632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN209566
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: