Healthcare Provider Details

I. General information

NPI: 1134584295
Provider Name (Legal Business Name): MAGGIE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16052 DOCTORS BLVD
HAMMOND LA
70403-1478
US

IV. Provider business mailing address

16052 DOCTORS BLVD
HAMMOND LA
70403-1478
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-9606
  • Fax: 985-345-9616
Mailing address:
  • Phone: 985-345-9606
  • Fax: 985-345-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08632
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN132157
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: