Healthcare Provider Details

I. General information

NPI: 1285963942
Provider Name (Legal Business Name): SHAWN LYNESE SMITH RN,WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

V. Phone/Fax

Practice location:
  • Phone: 910-583-9593
  • Fax:
Mailing address:
  • Phone: 910-488-2120
  • Fax: 910-482-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5004495
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: