Healthcare Provider Details

I. General information

NPI: 1932772373
Provider Name (Legal Business Name): STACI LEIGH SMART CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE
RIO RANCHO NM
87124-4740
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-3000
  • Fax: 505-253-3001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number809
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number809
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: