Healthcare Provider Details

I. General information

NPI: 1811727837
Provider Name (Legal Business Name): AERIANA MON'EY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CENTURY VILLAGE BLVD STE 200
MONROE LA
71203-2008
US

IV. Provider business mailing address

1700 POWELL ST
MONROE LA
71203-5752
US

V. Phone/Fax

Practice location:
  • Phone: 318-396-8500
  • Fax:
Mailing address:
  • Phone: 318-369-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number011914490
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: