Healthcare Provider Details

I. General information

NPI: 1831375567
Provider Name (Legal Business Name): STACEY ANN SMITH RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 05/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 VISTA DEL SOL
PRESCOTT AZ
86303-7268
US

IV. Provider business mailing address

783 VISTA DEL SOL
PRESCOTT AZ
86303-7268
US

V. Phone/Fax

Practice location:
  • Phone: 928-533-0166
  • Fax: 206-202-0410
Mailing address:
  • Phone: 928-533-0166
  • Fax: 206-202-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberL00610
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: