Healthcare Provider Details

I. General information

NPI: 1427288406
Provider Name (Legal Business Name): ALEAH R. SMITH-CLARK LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEAH RON SMITH

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N LAMAR BLVD
AUSTIN TX
78751-1820
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-483-5800
  • Fax: 512-483-5827
Mailing address:
  • Phone: 512-483-5800
  • Fax: 512-483-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number171244
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: