Healthcare Provider Details

I. General information

NPI: 1629093067
Provider Name (Legal Business Name): MARCY LOUISE SMITH ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST SUITE 400
AUSTIN TX
78705-1000
US

IV. Provider business mailing address

1400 N IH 35 SUITE 300
AUSTIN TX
78701-1926
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-3440
  • Fax: 512-406-6513
Mailing address:
  • Phone: 512-324-8300
  • Fax: 512-324-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number734860
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: