Healthcare Provider Details

I. General information

NPI: 1992244008
Provider Name (Legal Business Name): XUAN N SMITH RN CNOR RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 03/16/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N 11TH ST
BEAUMONT TX
77702-1500
US

IV. Provider business mailing address

PO BOX 2550
ROWLETT TX
75030-2550
US

V. Phone/Fax

Practice location:
  • Phone: 409-899-8372
  • Fax:
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number642029
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: