Healthcare Provider Details

I. General information

NPI: 1013553577
Provider Name (Legal Business Name): KIRA GILMORE SMITH APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HIGHWAY 190 STE C2
COVINGTON LA
70433-5057
US

IV. Provider business mailing address

PO BOX 669379
DALLAS TX
75266-9379
US

V. Phone/Fax

Practice location:
  • Phone: 985-773-1515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number208334
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: