Healthcare Provider Details

I. General information

NPI: 1447973797
Provider Name (Legal Business Name): BRENNA ASHLEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SIGLER AVE STE A
MEMPHIS MO
63555-1726
US

IV. Provider business mailing address

450 E SIGLER AVE
MEMPHIS MO
63555-1726
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-2828
  • Fax:
Mailing address:
  • Phone: 660-465-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2018012663
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023003913
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: