Healthcare Provider Details

I. General information

NPI: 1083616080
Provider Name (Legal Business Name): PAUL A SMITH ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N ELLIS ST
NEW BOSTON TX
75570-2904
US

IV. Provider business mailing address

5002 COWHORN CREEK RD
TEXARKANA TX
75503-9766
US

V. Phone/Fax

Practice location:
  • Phone: 903-628-1104
  • Fax: 903-628-0104
Mailing address:
  • Phone: 903-614-3000
  • Fax: 903-614-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number506033
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01143
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: