Healthcare Provider Details

I. General information

NPI: 1144138470
Provider Name (Legal Business Name): COBY DREW SMITH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 W HARRISON ST
SPRINGFIELD MO
65802-5757
US

IV. Provider business mailing address

4029 W HARRISON ST
SPRINGFIELD MO
65802-5757
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-9860
  • Fax:
Mailing address:
  • Phone: 417-761-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024043475
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: