Healthcare Provider Details

I. General information

NPI: 1609618222
Provider Name (Legal Business Name): ELENA SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 PONTCHARTRAIN DR
SLIDELL LA
70458-4827
US

IV. Provider business mailing address

1 HARRISON PLZ
FLORENCE AL
35632-0002
US

V. Phone/Fax

Practice location:
  • Phone: 985-238-0320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204817
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: