Healthcare Provider Details

I. General information

NPI: 1326717174
Provider Name (Legal Business Name): TAMI JO SMITH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E US HIGHWAY 175 STE 100
CRANDALL TX
75114-2950
US

IV. Provider business mailing address

1101 E US HIGHWAY 175 STE 100
CRANDALL TX
75114-2950
US

V. Phone/Fax

Practice location:
  • Phone: 346-766-1815
  • Fax: 346-766-1303
Mailing address:
  • Phone: 346-766-1815
  • Fax: 346-766-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1196536
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number181682
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1196536
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: