Healthcare Provider Details

I. General information

NPI: 1619078870
Provider Name (Legal Business Name): PAUL W. SMITH RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NORWOOD DR SUITE 145
HURST TX
76054-3638
US

IV. Provider business mailing address

PO BOX 822516
NORTH RICHLAND HILLS TX
76182-2516
US

V. Phone/Fax

Practice location:
  • Phone: 817-553-5303
  • Fax: 817-553-5304
Mailing address:
  • Phone: 817-553-5303
  • Fax: 817-553-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number241566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: