Healthcare Provider Details

I. General information

NPI: 1740074970
Provider Name (Legal Business Name): ANDREA LEIGH SMITHHEART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA LEIGH HOLDER RN

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 LARKWOOD DR
GREENSBORO NC
27410-3447
US

IV. Provider business mailing address

822 LARKWOOD DR
GREENSBORO NC
27410-3447
US

V. Phone/Fax

Practice location:
  • Phone: 512-922-6071
  • Fax:
Mailing address:
  • Phone: 512-922-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number302692
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: