Healthcare Provider Details

I. General information

NPI: 1558923649
Provider Name (Legal Business Name): SHARON SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LIMESTONE TER STE C-3
JARRELL TX
76537-1293
US

IV. Provider business mailing address

305 LIMESTONE TER STE C-3
JARRELL TX
76537-1293
US

V. Phone/Fax

Practice location:
  • Phone: 512-588-1501
  • Fax: 855-346-7410
Mailing address:
  • Phone: 512-588-1501
  • Fax: 855-346-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number645807
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142473
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: