Healthcare Provider Details

I. General information

NPI: 1730534348
Provider Name (Legal Business Name): DEVON ELIZABETH SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 COURT DR STE 450
GASTONIA NC
28054-2191
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-7652
  • Fax: 704-671-7656
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number291701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: